Morphine oral liquid alternative presentation listed

Patrizia Krieser From: Sent: Subject:

Follow Up Flag: Flag Status:

Jessica Birch <jessica.birch@pharmac.govt.nz> on behalf of David Hughes <david.hughes@pharmac.govt.nz> Wednesday, 15 November 2023 3:36 pm Supply issue: Morphine oral liquid, temporary alternative presentation listed from 1 December 2023 Follow up Flagged

Kia ora, From 1 December 2023, an alterna ve presenta on of morphine oral liquid will be temporarily listed on the Pharmaceu cal Schedule to cover an expected out of stock with the current funded brand.

The current funded presenta ons of morphine oral liquid are:  Morphine hydrochloride 1, 2, 5, and 10 mg per ml (200 ml) – RA-Morph (Pfizer), colourless to pale yellow From 1 December, the following 2mg per ml presenta on will be temporarily listed:  Morphine sulphate 10 mg per 5 ml (100 ml) – Wockhardt (Orspec Pharma), colourless to pale yellow Clinical advice states that the different salts in these brands (sulphate compared to hydrochloride) are interchangeable and have no impact on the equivalent dose of morphine.

Why is this happening?

Pfizer, who previously manufactured morphine hydrochloride oral liquid (RA-Morph) 1, 2, 5, and 10 mg per ml, announced in April it had sold its Perth manufacturing plant to another company, Bridgewest and stopped manufacturing morphine oral liquid. Following this, remaining stock of RA-Morph was transferred to Bridgewest’s New Zealand distributor, Juno, and is currently being supplied to the market.

Bridgewest have indicated they can resume manufacturing and supply all four strengths of morphine oral liquid to New Zealand from April 2024. Some of the RA-Morph presenta ons will expire/run out before this date, which is why we are lis ng the Wockhardt brand.

Affected products Morphine oral liquid presentation

Stock update

RA-Morph 1 mg per ml

Stock expected to run out during December 2023

RA-Morph 2 mg per ml

Sufficient until April 2024, stock expires end of March 2024

RA-Morph 5 mg per ml

Sufficient until April 2024, stock expires end of March 2024

RA-Morph 10 mg per ml

Stock expires end of November 2023

Stock of RA-Morph 1 mg per ml is currently expected to run out during December 2023, leaving a supply gap of five months for this strength before Bridgewest can enter the market.

We have been unable to source a 1 mg per ml formula on, which would have been our preference.

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Resources for people using morphine oral liquid A Healthify educa onal leaflet to support people using morphine oral liquid is being developed and will be available on the Healthify website and the Pharmac website soon.

Advice for pharmacy: 

Pharmacists will need to ensure those affected and their whānau and caregivers are counselled on the strength of morphine oral liquid that they are receiving, so they are aware of what volume they need to receive the appropriate dose. To support this, a brand switch fee will be claimable from 1 December 2023 to 29 February 2024.



Please take extra cau on with the different labelling of strength of Wockhardt morphine oral liquid. Wockhardt oral morphine strength is labelled as per 5 ml, whereas the other presenta ons are labelled as per ml.



A 1 mg per ml formula on is expected to be available again in April 2024.

Stock of RA-Morph 10 mg per ml expires at the end of November 2023. We have previously no fied the sector about using RA-Morph 5 mg per ml un l April 2024 when a 10 mg per ml formula on is available. There is s ll sufficient stock of RA-Morph 5 mg per ml for this.

Wockhardt morphine oral liquid not approved by Medsafe Wockhardt morphine oral liquid is not approved by Medsafe and will therefore need to be supplied in line with Sec on 29 of the Medicines Act 1981. While not approved for use in New Zealand, Wockhardt morphine oral liquid 10 mg per 5 ml is approved and used in the UK. We know lis ng an unapproved medicine is not ideal. We understand this may cause concern and frustra on, however, in this case, we consider this the only op on to ensure a morphine oral liquid product remains available for people to use.

More informa on You can find more informa on about this change and what it means for you on the Pharmac website. Please share this informa on. We want to make sure everyone who needs to know about this change is aware.

Ngā mihi nui, David Hughes David Hughes (he/him) Chief Medical Officer | Tumu Whakarae Haumanu ___________________________________________________________________ Pharmac | Te Pātaka Whaioranga | PO Box 10 254 | Level 9, 40 Mercer Street, Wellington P: +64 4 460 4990 | M: +64 21 962 317 | F: +64 4 460 4995 | www.pharmac.govt.nz This e-mail message and any accompanying attachments may contain confidential information. If you are not the intended recipient, please do not read, use, disseminate, distribute or copy this message or attachments. If you have received this message in error, please notify the sender immediately and delete this message. This e-mail message and any accompanying attachments may contain confidential information. If you are not the intended recipient, please do not read, use, disseminate, distribute or copy this message or attachments. If you have received this message in error, please notify the sender immediately and delete this message.

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