ACTISKENAN 5 Mg Gélule Box of 14

ACTISKENAN 5 Mg Gélule Box of 14
Therapeutic class:   Analgesics
Active ingredients:   Sulfate morphine
Statute:   Drug subjected to medical regulation
Rate of refunding S:   65%
Laboratory:   Bristol-board Myers Squibb

Indications

Intense or rebellious pains with analgesics of lower level, in particular pains of cancerous origin.

Posology

Reserved with the adult and the child of more than 6 months.
The oral form with morphine immediate liberation is mainly adapted to particular clinical situations: urgencies, fast balancing of very intense pains, unstable pains, metabolic disorders (impaired renal function), elderly.
MODE Of ADMINISTRATION:
Oral way.
- With the forms with immediate liberation, the amount total day laborer is generally divided into six catches, generally equivalent, at 4 hours of interval.
- One can also use this form like proportions additional in the event of painful access not controlled by a basic treatment (for example, morphine with prolonged release).
- In the child of less than 6 years the gélule MUST be open; there exists a risk of false route in the event of administration of the whole gélule. Among patients not being able to swallow the whole gélule, one can manage his contents directly in a semi-solid food (mashed potatoes, jam, yoghourt), or in gastric probes or of gastrostomy of diameter higher than 16 F.G and/or diameter interns equal to or higher than 2,5 mm at open distal end or side pores. A rinsing of the probe with 10 to 50 ml of water is sufficient.
INITIAL POSOLOGY:
- In the adult:
In general, the amount day laborer starting is of 10 Mg every 4 hours, that is to say 60 Mg per day.
- At the fragile patients:
All posologies are reduced by half and/or separated by 6 to 8 a.m. (patient very old, impaired renal function or hepatic, hypoprotidemy…).
- At the very old subject:
It is advisable to begin the treatment with a posology of about 2,5 to 5 Mg from oral morphine LI 4 to 6 times per day, that is to say 10 to 30 Mg per day.
- In the child:
The amount day laborer starting is of 1 mg/kg and per day.
- At the insufficient renal one:
The amounts also reduced compared to a subject with normal renal function and will be adjusted according to the needs for the patient.
- If the morphine treatment requires to be continued several weeks, the morphine LI regulation can be relayed by morphine LP with amount equivalent day laborer.
POSOLOGICAL ADAPTATION:
- Frequency of the evaluation:
One should not be delayed on a posology which proves to be ineffective. The patient must thus be seen in a way brought closer mainly with setting-up of the treatment, as long as the pain is not controlled.
- Posological Adaptation:
. If the pain is not controlled, the morphine LI unit dose can be increased by 25 to 50% depending on the age and the physiological state of the patient.
. In the event of insufficiency of relief, the patient can have recourse to a interdose every hour without exceeding 4 successive catches in four hours.
. If the patient uses regularly more than 3 or 4 interdoses divided in the course of the day, these additional amounts must be integrated in the daily total morphine LI posology without waiting more than 48 hours.
. In these processes of adjustment of the amounts, there is no higher limit as long as the undesirable effects can be controlled.
- Correspondence enters the various routes of administration:
Posology varies according to the route of administration.
Compared to the oral way, posology by intravenous way must be divided by three and posology by subcutaneous way must be divided by two.
The passage of a route of administration to another must take account of these coefficients in order to maintain the same quantity of biodisponible morphine.
In the event of relay of an oral form with immediate liberation with an oral form with prolonged release, daily posology will be unchanged.

Against indications

CONTRA-INDICATE:
- This drug should never be used in the following cases:
. known over-sensitiveness with morphine or all other composing of the product,
. child of less than 6 months,
. décompensée respiratory insufficiency (in the absence of artificial ventilation),
. severe hépatocellulaire insufficiency (with encephalopathy),
. into acute: cranial traumatism and intracranial hypertension in the absence of controlled ventilation,
. not controlled epilepsy,
. breast feeding, in the event of introduction or of continuation after the birth of a treatment the long course,
. associations with the buprénorphine, the nalbuphine and the pentazocine (see heading interactions).
- Because of the presence of saccharose, this drug should not be used in the event of intolerance with the fructose, of syndrome of malabsorption of glucose and galactose or of invert sugar-isomaltase deficit.
DISADVISE:
Disadvised associations: naltrexone; alcoholic drinks and drugs containing of alcohol.

Undesirable effects

- Among the most frequent undesirable effects during the initiation of the treatment, somnolence, a confusion, nauseas and vomiting are brought back. They can be transitory but their persistence must make seek an associated cause or an overdose. The constipation on the other hand does not yield to the continuation of the treatment. All these effects are foreseeable and require to be treated.
- One can also note:
. sedation, excitation, nightmares, more especially at the old subject, with possibly hallucinations;
. respiratory depression with to the apnea maximum;
. increase in the intracranial pressure, which it is advisable to treat initially;
. dysurie and urinary retention in the event of adenoma prostatic or of sténose urethral;
. prurit and redness;
. syndrome of weaning to the brutal stop of this drug: yawns, anxiety, irritability, insomnia, shivers, mydriase, puffed out heat, sudation, whimpering, rhinorrhée, nauseas, vomiting, anorexia, cramps abdominal, diarrheas, myalgias, arthralgies.
- At the old or insufficient subjects renal, exceptional risk of appearance of myoclonies in the event of overdose or too fast increase in the amounts.