Morphine oral liquid

• Morphine hydrochloride oral liquid 1mg/ml (RA-Morph; Pfizer) supplies are expected to run out in December, and become available again in April 2024. To cover this supply gap, morphine sulphate oral liquid 10mg/5ml [2mg/ml] (Wockhardt; Orspec Pharma) will be temporarily listed on the Pharmaceutical Schedule from 1 December 2023.¹

• Although the two brands have different morphine salts, hydrochloride compared to sulphate, this has no impact on the equivalent dose of morphine.¹

• Prescribers are cautioned that the temporary morphine oral liquid alternative (Wockhardt) is of a different strength to the incumbent lower strength oral liquid (RA-Morph) and is of differing presentation from other morphine oral liquids.

• As Wockhardt morphine oral liquid 10mg/5ml is not approved in New Zealand, it will be supplied under Section 29 of the Medicines Act 1981.²

Visit the Medicine funding and supply page on the Pharmac website for more information.

Morphine oral liquid was previously manufactured by Pfizer, in Perth. However, in April 2023, Pfizer divested the Perth manufacturing plant to Bridgewest and stopped manufacturing morphine oral liquid (RA-Morph) to Bridgewest's nominated New Zealand supplier, Juno Pharmaceuticals.¹

Bridgewest has indicated they can resume manufacturing and supply of morphine oral liquid to New Zealand from April 2024. The five-month gap in supply of morphine oral liquid RA-Morph 1mg/ml will be covered by Wockhardt morphine oral liquid 10mg/5ml.

Sufficient supplies of morphine oral liquid RA-Morph 2mg/ml and 5mg/ml strengths remain. However, supplies of RA-Morph 10mg/ml will run out by the end of November 2023.¹

The strength and presentation of Wockhardt morphine oral liquid 10mg/5ml differs to that of the incumbent RA-Morph morphine oral liquid 1mg/ml. The Wockhardt brand is double the strength of the RA-Morph brand, and Wockhardt is presented as milligrams per five millilitres, whereas RA-Morph is presented as milligrams per one millilitre (see table). These differences mean prescribers must take extra care.

Table: Morphine oral liquid presentation

Wockhardt morphine oral liquid 10mg/5ml is not approved by Medsafe so may only be prescribed and supplied under Section 29 of the Medicines Act 1981² after obtaining informed consent from the patient.

Furthermore, RA-Morph 1mg/ml repeat prescriptions cannot be substituted with Wockhardt 10mg/5ml due to Section 29 legislation requirements. Patients who have a repeat for RA-Morph 1mg/ml waiting to be dispensed will need a new prescription from their doctor.

Requirements under Section 29

Two key requirements of prescribing Wockhardt morphine oral liquid 10mg/5ml under Section 29 include:

1. Wockhardt morphine oral liquid may only be prescribed by a person registered with the Medical Council of New Zealand (ie, a doctor).
2. Informed consent must be obtained from the patient.

Useful resources with full details of requirements for prescribing under Section 29 and obtaining informed consent can be found below.

• Use of unapproved medicines and unapproved use of medicines – Medsafe.²
• Informed Consent: Helping patients make informed decisions about their care – Medical Council of New Zealand , 2021 (PDF).³
• Unapproved medicines (and informed consent) – Healthify (patient and clinician resources).⁴

Wockhardt morphine oral liquid 10mg/5ml is approved in the UK and clinicians are recommended to consult product and prescribing information, which can be found in the UK’s Medicines & Healthcare Products Regulatory Agency (MHRA) Public Assessment Report (PAR).⁵

Pharmacists should counsel patients and their whānau/caregivers about the strength of morphine oral liquid they are dispensed, to ensure they are aware of the correct volume necessary to achieve the appropriate dose. As support for this, a brand switch fee will be claimable from 1 December 2023 to 29 February 2024.¹