Morphine oral liquid: Supply issue

Background

Pfizer previously manufactured morphine oral liquid (RA-Morph) 1, 2, 5, and 10 mg per ml. In April 2023, Pfizer sold its Perth manufacturing plant to another company, called Bridgewest Group, and stopped manufacturing morphine oral liquid.

Pfizer has transferred remaining stock of morphine oral liquid (RA-Morph) to Bridgewest's nominated New Zealand supplier, Juno Pharmaceuticals, and this is currently being supplied.

Bridgewest has indicated it can resume manufacturing and supply all four strengths of morphine oral liquid to New Zealand from April 2024.

Some of the RA-Morph presentations will expire or run out before this date.

Affected product

The current funded presentations of morphine oral liquid are:

• Chemical: Morphine hydrochloride
• Presentations: 1, 2, 5 and 10 mg per ml (200 ml)
• Brand (Supplier): RA-Morph (Pfizer)
• Description: colourless to pale yellow

Schedule listing for morphine oral liquid(external link)

Morphine oral liquid 1 mg per ml

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.

Morphine oral liquid 1 mg per ml is the most used strength of morphine oral liquid, making up 80% of total dispensing.

Because of this, remaining stock of RA-Morph 2 mg per ml will not be enough to cover cover both the 1 mg per ml market and the 2mg per ml market. An alternative product is needed to cover the gap in supply.

What we are doing

From 1 December 2023, an alternative presentation of morphine oral liquid will be temporarily listed on the Pharmaceutical Schedule to cover the gap in supply expected for RA-Morph 1 mg per ml.

The temporary brand of morphine oral liquid is:

• Chemical: Morphine sulphate
• Presentation: 10 mg per 5 ml (2 mg per ml) (100 ml)
• Brand (Supplier): Wockhardt (Orspec Pharma)
• Description: Colourless to pale yellow

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

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.

Information for people using morphine oral liquid

If you have a repeat for morphine oral liquid 1 mg per ml (RA-Morph) waiting to be dispensed at your pharmacy, you will need to get a new prescription for the Wockhardt brand. Please talk to your pharmacist about this if you are not sure.

A Healthify educational leaflet to support people using morphine oral liquid is being developed and will be available soon to help with this change.

Advice for pharmacy

Pharmacists will need to ensure people affected by this 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.

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

Repeats for RA-Morph 1 mg per ml cannot be substituted with Wockhardt 10 mg per 5 ml (2 mg/ml). This will mean people who have a repeat waiting to be dispensed for RA-Morph 1 mg per ml will need a new prescription from their doctor.

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

Brand switch fee for pharmacists

We know that counselling people with this change may be difficult. To support this, a brand switch fee will be claimable from 1 December 2023 to 29 February 2024.

This is the first brand change for morphine oral liquid, and also means a change in strength and salt. We know some people using morphine oral liquid will need additional support from their pharmacist with this change, and may have questions.

This is an opportunity to provide some extra counselling to ensure people, their whānau and caregivers are aware of the strength of morphine oral liquid that they are receiving, and are aware of what volume they need to receive the appropriate dose.

More about brand switch fees(external link)

We appreciate the time you take to help people understand brand changes. Healthify are developing a pamphlet you can download and print for patients, whānau or carers. 

Link here when available

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 Section 29 of the Medicines Act 1981.

While not approved for use in New Zealand, Wockhardt morphine oral liquid 10 mg per 5 ml (2 mg/ml) is approved and used in the UK.

We know listing an unapproved medicine is not ideal and will restrict prescribing to medical practitioners where the patient is known. In this case however, we consider this is a better option than not having morphine oral liquid available.

Advice for prescribing under section 29 – BPAC website(external link) 

Prescriber and pharmacist requirements for section 29 medicines – Medsafe website(external link)

Medsafe’s section 29 Declaration / Notification Form [DOC](external link)

What patients need to know about unapproved medicines – Healthify website(external link)

Morphine oral liquid 2 mg and 5 mg per ml

Stock of RA-Morph 2 mg and 5 mg per ml is sufficient to last until April 2024 when Bridgewest enters the market, however, stock of these strengths expires on 31 March 2024.

Noting the timeframe of expiry, we anticipate Wockhardt 10 mg per 5 ml (2 mg/ml) may also be needed to cover these strengths from early March 2024.

Other medicines affected by this

Pfizer’s Perth manufacturing plant makes some other sterile injectable medicines which are supplied to the New Zealand market.

Please see the following link for information on what Pharmac has done to date to ensure continued supply of these medicines:

Medicines affected by Pfizer selling the Perth manufacturing plant(external link)

Who to contact

If you have questions about morphine oral liquid, please email enquiry@pharmac.govt.nz

Please include as much information as you can about the product (presentation, brand, pharmacode) and who your wholesaler is.  

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