What is SEVREDOL?
SEVREDOL is a brand of morphine, an opioid pain reliever classified as a natural opium alkaloid. It contains the active ingredient morphine sulfate and is formulated as an immediate-release (IR) tablet, meaning it is designed to relieve severe pain quickly. It is often prescribed for the management of acute pain or breakthrough pain in patients already on other long-acting opioids. SEVREDOL is typically taken every four hours, providing a short-term, powerful analgesic effect.
The Mechanism of Action
As an opioid agonist, the principal therapeutic action of morphine is to relieve pain. Its mechanism involves binding to specific opioid receptors, primarily the mu-opioid receptors, found throughout the central nervous system (CNS), including the brain and spinal cord. This binding action mimics the effect of the body's natural pain-relieving compounds, leading to a reduction in the perception of pain.
How opioid receptors work
- Mu-opioid receptors: The primary site of action for morphine, these receptors are responsible for supraspinal analgesia (pain relief originating from the brain), euphoria, and respiratory depression.
- Kappa-opioid receptors: Morphine also binds to these receptors, though to a lesser extent, which contributes to spinal analgesia and sedation.
Beyond pain relief, morphine's action on the CNS also leads to sedation, miosis (pinpoint pupils), and depression of the cough reflex. In the gastrointestinal tract, it increases smooth muscle tone and decreases motility, which commonly results in constipation.
Indications for Use
SEVREDOL is indicated for the relief of severe pain, particularly in the context of cancer. It is not intended for the management of mild pain. The immediate-release formulation makes it suitable for several scenarios:
- Acute pain: For severe, sudden-onset pain that requires rapid relief.
- Breakthrough pain: For episodes of severe pain that occur despite a patient already being on a regular, long-acting opioid regimen.
- Titration: To help determine the appropriate dose of a longer-acting opioid for chronic pain management.
Dosage and Administration
Dosage must be individualized based on the patient's pain severity, previous analgesic history, and overall condition.
- Administration: SEVREDOL tablets should be swallowed whole with a glass of water. Crushing or injecting the tablets is extremely dangerous and can be fatal.
- Titration: During the initial days of treatment, the dose may be adjusted by a physician to find the lowest effective dose.
- Elderly and impaired patients: Lower starting doses are typically recommended for elderly patients or those with renal or hepatic impairment due to altered metabolism.
Side Effects and Serious Risks
Like all opioid medications, SEVREDOL carries a risk of side effects, some of which can be life-threatening. The risk of side effects increases with higher doses and longer duration of use.
Common side effects
- Gastrointestinal: Constipation and nausea are very common.
- CNS: Drowsiness, dizziness, headache, and confusion are also frequently reported.
- Psychiatric: Insomnia and altered mood.
- Other: Sweating, flushing, and itching.
Serious risks
- Respiratory depression: Life-threatening or fatal respiratory depression is a major risk, especially when starting treatment, increasing dosage, or if combined with other CNS depressants.
- Abuse and dependence: SEVREDOL has a high potential for abuse, misuse, and addiction, which can lead to overdose and death. Physical dependence and tolerance can develop with repeated use.
- Withdrawal: Abrupt discontinuation can cause severe withdrawal symptoms, including anxiety, agitation, muscle aches, and gastrointestinal distress.
- Serotonin syndrome: This can occur when opioids are used with certain other medications, potentially causing a range of symptoms including agitation, hallucinations, and rapid heart rate.
Comparison of SEVREDOL with Other Opioids
| Feature | SEVREDOL (Immediate-Release Morphine) | MS Contin (Extended-Release Morphine) | Oxycodone (e.g., OxyContin) |
|---|---|---|---|
| Onset of Action | Rapid (~1 hour) | Delayed (extended release over 8-12 hours) | Rapid (for immediate release) or delayed (for extended release) |
| Duration of Action | Short (typically 4 hours) | Long (up to 12 hours) | Variable, depending on formulation |
| Primary Use | Acute pain, breakthrough pain, dose titration | Chronic, around-the-clock pain management | Acute and chronic pain management |
| Relative Potency | Standard benchmark for opioid potency | Equivalent to oral SEVREDOL, but extended duration | More potent than oral morphine; equianalgesic dose is lower |
| Abuse Potential | High; potential for misuse due to rapid onset | High; potential for abuse, especially if crushed | High; significant risk of abuse |
Contraindications and Drug Interactions
Before prescribing SEVREDOL, a thorough medical history is essential to identify potential contraindications and drug interactions. Patients should not take SEVREDOL if they have:
- A known allergy or hypersensitivity to morphine or its excipients.
- Severe respiratory conditions, including acute asthma or respiratory depression.
- Gastrointestinal obstructions, such as paralytic ileus or delayed gastric emptying.
- Used a monoamine oxidase inhibitor (MAOI) in the last 14 days.
- A head injury or increased intracranial pressure.
- Severe liver disease.
Significant drug interactions
- Central Nervous System (CNS) Depressants: The co-administration of SEVREDOL with alcohol, benzodiazepines, sedatives, or other opioids can increase the risk of severe sedation, respiratory depression, coma, and death.
- Anticoagulants: Morphine can affect the activity of certain anticoagulants, potentially altering their effects.
- Anticholinergics: These drugs can potentiate the anticholinergic side effects of morphine, such as constipation.
Conclusion
SEVREDOL, as an immediate-release formulation of morphine sulfate, is a potent medication for managing severe pain. While highly effective, its use requires careful consideration due to the significant risks associated with opioid analgesics, including dependence, abuse, and life-threatening respiratory depression. Patients must be closely monitored by a healthcare professional throughout treatment. Proper dosage, administration, and adherence to medical advice are crucial for ensuring the medication's therapeutic benefits outweigh its potential harms.
For more detailed information on appropriate prescribing and risk mitigation strategies, healthcare professionals can consult official product information and guidelines from regulatory bodies like the European Medicines Agency (eMC) and national health authorities.
