Kadian, MoRu-Viraten Berna, Norvir

Lu-ann Murdoch, B.Sc.Phm.

Knoll Pharma is now marketing Kadian (morphine sulfate 20 mg, 50 mg and 100 mg sustained-release capsules), an opioid analgesic administered once daily for the relief of chronic pain. Following oral administration of Kadian, peak plasma concentrations of morphine occur at approximately 8.5 hours (about 10 hours if administered with food). Dosage adjustments with Kadian should generally be separated by 48 hours.

There is no experience with the use of Kadian as the initial opioid in the management of pain. Pain therapy is usually begun using an immediate-release formulation of morphine, because it is easier to titrate the dosage using this format.

Patients receiving immediate-release formulations of morphine can be transferred to Kadian by administering the total daily amount of morphine as a single dose of Kadian administered every 24 hours. The first dose of Kadian should be taken with the last dose of the immediate-release morphine product.

Patients receiving other sustained-release formulations of morphine can also be converted to Kadian using the same total daily morphine dose given once daily every 24 hours. Kadian should be started at the time of the next scheduled dose of morphine.

The product monograph should be consulted for the factors to consider when converting patients from other oral opioids or parenteral opioids to Kadian.

Kadian capsules may be administered with or without food. The capsules contain sustained-release pellets which may be sprinkled onto soft food, but should not be chewed or crushed, as this may cause the release of a potentially toxic dose of morphine.

MoRu-Viraten Berna is a live, attenuated measles and rubella vaccine from Berna Products. It is the first measles-containing vaccine without any avian protein content, and can be given without regard to egg or avian protein hypersensitivity.

The vaccine is indicated for immunization against measles (rubeola) and rubella (German measles) in individuals 12-15 months of age and older. The recommended dosage is 0.5 mL, administered subcutaneously into the deltoid region of the upper forearm.

Children immunized at 12-15 months should be revaccinated at four to six years of age, or at the age of 11-12 years when a combined measles, mumps, rubella vaccine is recommended.

The most common side effects are local reactions at the injection site, e.g., tenderness, erythema, swelling, urticaria. Occasional adverse effects include fever, malaise, headache, runny nose, sore throat and conjunctivitis.

Abbott Laboratories has launched a new protease inhibitor, Norvir (ritonavir 100 mg capsules, 80 mg/mL liquid). The drug is indicated in combination with reverse-transcriptase inhibitor nucleoside analogues (e.g., zidovudine, didanosine, zalcitabine) for the treatment of human immunodeficiency virus (HIV) infection.

The recommended dosage is 600 mg orally twice daily with meals. If patients experience nausea, more gradual introduction of the drug over a four-day period can be attempted. The taste of the oral solution may be improved by mixing it with chocolate milk, Ensure or Advera, within one hour of administration.

Gastrointestinal and neurological disturbances have been the most common adverse reactions in patients receiving ritonavir-nucleoside analogue combinations. These include nausea, diarrhea, vomiting, anorexia, abdominal pain, taste perversion and paresthesias.

Ritonavir may produce large increases in the plasma concentration of numerous drugs including a number of antiarrhythmics, nonsedating antihistamines, sedative-hypnotics, anticonvulsants, antidepressants and immunosuppressants. Some agents are contraindicated during ritonavir therapy, whereas others may be administered as long as they are accompanied by close monitoring.

Other new products


  • Apotex has introduced three new products: Apo-Buspirone, an anxiolytic containing buspirone 10 mg/tablet; Apo-Fluoxetine, an antidepressant containing fluoxetine 10 mg or 20 mg/capsule; and Apo-Loperamide, an antidiarrheal agent containing loperamide 2 mg/tablet.New dosage forms
  • Mepron Suspension (atovaquone 750 mg/5 mL) is now available from Glaxo Wellcome. The product is indicated for the acute oral treatment of mild to moderate Pneumocystis carinii pneumonia in patients who are intolerant to trimethoprim-sulfamethoxazole. The suspension is a microfluidized formulation with a significantly reduced particle size of atovaquone compared to Mepron tablets. The bioavailability of atovaquone from the suspension formulation is almost twice that provided by Mepron tablets. The recommended dosage of Mepron suspension is 750 mg (5 mL) administered with food twice daily for 21 days.
  • SmithKline Beecham is marketing 125 mg and 250 mg tablets of the antiviral Famvir (famciclovir), in addition to the original 500 mg tablets. (See also new indication for Famvir.)
  • Zoladex LA (goserelin acetate 10.8 mg) depot injection is being introduced by Zeneca Pharma for the palliative treatment of patients with advanced prostate carcinoma. The usual dosage is 10.8 mg administered subcutaneously every 12 weeks into the anterior abdominal wall.New indications
  • SmithKline Beecham’s Famvir (famciclovir) is now approved for the treatment of recurrent episodes of genital herpes, in addition to the treatment of acute herpes zoster (shingles). The drug is initiated during the prodrome of recurrent genital herpes, or as soon as possible after the onset of lesions, to decrease the duration of viral shedding and the time required for lesion healing and resolution of symptoms (pain, tenderness, itching and burning). The recommended dosage is 125 mg twice a day, with or without food, for five days. (See also new dosage form for Famvir.)Monograph revisions
  • Janssen has revised the drug interactions and contraindications sections of the Sporanox (itraconazole) product monograph, to incorporate information about
    a potential interaction with lovastatin. Itraconazole inhibits the metabolism of lovastatin, resulting in increased plasma concentrations of lovastatin and its active metabolite. This could lead to an increased risk of skeletal
    muscle toxicity such as diffuse myalgia and rhabdomyolysis. As a result, HMG­CoA reductase inhibitors such as lovastatin should not be used during treatment with itraconazole.New dosage
  • Rhône-Poulenc Rorer’s bronchial anti-inflammatory agent, Tilade (nedocromil sodium) inhalation is now approved for use in children seven to 12 years of age, in addition to adults and children over the age of 12. The recommended dosage for initial and maintenance therapy for adults and children over six years of age is two actuations (4 mg) four times daily.Discontinued products
  • Fournier Pharma has discontinued Lipidil (fenofibrate) 100 mg capsules. The product was administered in a three times daily dosage schedule for the treatment of dyslipidemias. Lipidil Micro (fenofibrate micronized 200 mg
    continue to be marketed; the micronized product can be given once daily, which may improve patient compliance.
  • Parke-Davis has discontinued Pro-Air (procaterol HCl), an inhaled beta2-agonist bronchodilator used for the treatment of bronchospasm.Lu-Ann Murdoch is the consulting clinical editor of Pharmacy Practice.