kaolin light + morphine + sodium hydrogen carbonate: clinical use

Prescribing considerations

• Confirm that symptomatic treatment is appropriate and assess dehydration or red-flag gastrointestinal symptoms.
• Review concurrent opioids, sedatives and medicines whose absorption may be reduced.
• Consider dependence risk factors and counsel about opioid-use disorder despite the low morphine concentration.
• Account for the product's sodium, ethanol, sucrose, fructose, benzyl alcohol and parahydroxybenzoate content.
• Use caution with renal impairment, heart failure, cirrhosis, hypertension, reduced respiratory reserve, hypotension, hypothyroidism, prostatic hypertrophy and frailty.

Contraindications and cautions

• Intestinal obstruction or likely paralytic ileus
• Respiratory depression or obstructive airways disease
• Acute hepatic disease, acute alcoholism, head injury, coma, convulsive disorders or raised intracranial pressure
• Morphine or excipient hypersensitivity
• Concurrent MAOI treatment or use within two weeks of stopping
• Metabolic or respiratory alkalosis, hypocalcaemia or hypochlorhydria
• Relevant hereditary fructose, glucose-galactose or sucrase-isomaltase disorders

Monitoring

• Sedation and respiratory depression, particularly with other central nervous system depressants
• Constipation, urinary retention and biliary or pancreatic symptoms
• Signs of misuse, tolerance, dependence or opioid-use disorder
• Fluid status and persistence or worsening of the underlying gastrointestinal illness

Clinical pharmacology

Kaolin is a non-absorbed intestinal adsorbent; sodium hydrogen carbonate is an alkalising antacid; morphine reduces intestinal peristalsis. Oral morphine undergoes substantial first-pass metabolism, crosses the placenta and appears in breast milk.

Formulation and product differences

• The product is a buff-coloured oral suspension that separates on standing and requires shaking.
• It contains ethanol, sodium, sucrose, fructose, benzyl alcohol, benzyl benzoate and parahydroxybenzoate preservatives.
• It is supplied in a glass bottle and should be kept tightly closed below 25°C.