Kadian: Uses, Side Effects and Dosage

Serious warnings and precautions box

What KADIAN is used for:

KADIAN is used for the long-term management of pain, when:

• the pain is severe enough to require daily, around-the-clock medication.

• the healthcare professional determines that other treatment options are not able to effectively manage your pain.

KADIAN is NOT used “as needed” to treat pain that you only have once in a while.

How KADIAN works:

KADIAN is an oral extended release capsule that slowly releases morphine sulphate over a 24-hour period.

KADIAN contains morphine sulphate which is a pain medication belonging to the class of medicines known as opioids which also includes codeine, fentanyl and oxycodone. It relieves pain by acting on specific nerve cells of the spinal cord and brain.

The ingredients in KADIAN are:

Medicinal ingredient(s): morphine hemisulfate 2.5 – hydrate

Non-medicinal ingredients: Diethyl Phthalate, Ethylcellulose N-50, Gelatin, Hypromellose, Methacrylic acid - ethyl acrylate copolymer (1:1), Type A, Polyethylene Glycol 6000 (Macrogol 6000), Talc, Sugar Spheres, and a black ink containing: ammonium hydroxide, the colouring agent E172 (black iron oxide), potassium hydroxide, propylene glycol, and shellac.

KADIAN comes in the following dosage form(s):

Capsules:

• 10 mg (marked “K10”, with one black band)
• 20 mg (marked “K20”, with two black bands)
• 50 mg (marked "K50”, with three black bands)
• 100 mg (marked "K100”, with four black bands)
• 200 mg (marked “K200”, with no printing on body)

Do not use KADIAN if:

• your healthcare professional did not prescribe it for you
• you are allergic to morphine sulphate pentahydrate, other opioids, or any of the other ingredients of KADIAN. You are reminded that KADIAN contains sucrose and propylene glycol.
• you have mild or short-term pain that can be controlled by the occasional use of pain medication, including those available without a prescription.
• you have severe asthma, trouble breathing, or other lung problems.
• you have a condition where the small bowel does not work properly (paralytic ileus) or you have severe pain in your abdomen.
• you have gallbladder disease, bile duct disease or problems with your pancreas.
• you have a head injury
• you are at risk for seizures.

• you suffer from alcoholism.

• you have an irregular heartbeat.
• you are taking, or have taken within the past 2 weeks, a monoamine oxidase inhibitor medication (e.g., phenelzine sulphate, tranylcypromine sulphate, moclobemide or selegiline).
• you are pregnant or plan to become pregnant, breast feeding, or in labour.
• you are under 18 years of age.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take KADIAN. Talk about any health conditions or problems you may have, including if you:

• have a history or family history of illicit or prescription drug or alcohol abuse.
• have severe kidney, liver, or lung disease.
• have heart disease.
• have low blood pressure.
• have past or current depression.
• have other gastrointestinal problems such as constipation.
• have problems with your thyroid, adrenal or prostate gland.
• have inflammatory bowel disease or gallbladder disease.
• have problems with your pancreas.
• are going to have, or recently had, a planned surgery.
• have, or had in the past, hallucinations or other severe mental problems.
• suffer from migraines.
• have a blood disorder known as sickle cell disease (SCD).
• have or have had problems with your mood (such as depression or anxiety) or other mental health problems.
• have a sleep disorder which causes pauses in breathing or shallow breathing while sleeping (sleep apnea).

Other warnings you should know about:

Opioid dependence and addiction: Like any opioid, KADIAN may cause mental and physical dependence; it also has the potential to cause addiction. There are important differences between physical dependence and addiction. If you use opioids for a long time, you may develop tolerance. This means that you may need high doses of KADIAN to feel the same level of pain relief. It is important that you talk to your healthcare professional if you have questions or concerns about abuse, addiction, physical dependence, or tolerance. Your healthcare professional should prescribe KADIAN with the same degree of caution appropriate to the use of other oral opioid medications. It is not recommended to use these products for a long period of time.

Pregnancy, nursing, labour and delivery: Do not use KADIAN while pregnant, nursing, during labour or delivery. Opioids can be transferred to your baby through breast milk, or while still in the womb. KADIAN can then cause life-threatening breathing problems in your unborn baby or nursing infant.

Driving and using machines: Before you do tasks which may require special attention, you should wait until you know how you react to KADIAN. KADIAN can cause:

• drowsiness
• dizziness or
• light headedness

This can usually occur after you take your first dose and when your dose is increased.

Disorder of the adrenal gland: You may develop a disorder of the adrenal gland called adrenal insufficiency. This means that your adrenal gland is not making enough of certain hormones. You may experience symptoms such as:

• nausea, vomiting
• feeling tired, weak or dizzy
• decreased appetite

You may be more likely to have problems with your adrenal gland if you have been taking opioids for longer than one month. Your healthcare professional may do tests, give you another medication, and slowly take you off KADIAN.

Serotonin toxicity (also known as Serotonin Syndrome): KADIAN can cause serotonin toxicity, a rare but potentially life-threatening condition. It can cause serious changes in how your brain, muscles and digestive system work. You may develop serotonin toxicity if you take KADIAN with certain antidepressants or migraine medications.

Serotonin toxicity symptoms include:

• fever, sweating, shivering, diarrhea, nausea, vomiting;
• muscle shakes, jerks, twitches or stiffness, overactive reflexes, loss of coordination;
• fast heartbeat, changes in blood pressure;
• confusion, agitation, restlessness, hallucinations, mood changes, unconsciousness, and coma

Sexual Function and reproduction: Long term use of opioids may lead to a decrease in sex hormone levels. It may also lead to low libido (desire to have sex), erectile dysfunction or being infertile.

Sleep Apnea: Opioids can cause a problem called sleep apnea. This is a sleep disorder where you have pauses in your breathing, or shallow breathing while sleeping. Tell your healthcare professional if you have a history of sleep apnea or if anyone notices that you have irregular breathing while sleeping.

Worsening pain: Taking opioids for pain can sometimes have the unintended effect of making your pain feel worse (opioid-induced hyperalgesia). This can occur even if your dose has not been changed or increased. This can include feeling pain in new places in your body, or from something that would not normally hurt, for example, feeling pain from clothing touching your skin. Tell your healthcare professional if you notice a change like this in your pain while taking KADIAN.

Gastrointestinal disorders: Taking opioids for a long time can cause problems with your throat that can affect swallowing. This usually happens within weeks to months after starting treatment with an opioid medication. Common symptoms include difficulty swallowing, heartburn, and chest pain. Serious gastrointestinal problems can also occur such as muscle spasms or obstruction of the esophagus.

Testing and check-ups: Your healthcare professional will regularly monitor your health. This includes monitoring for signs of:

• misuse and abuse;
• sleep apnea;
• respiratory depression and sedation (e.g., slow, shallow, or weak breathing)

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

Serious drug interactions:

The following may also interact with KADIAN:

• migraine medicines (5-HT1 agonists also called triptans).
• medicines used to prevent blood clots such as anticoagulants (e.g., warfarin, coumadin) and antiplatelets (e.g., clopidogrel, prasugrel, ticagrelor)
• anti-retroviral, anti-fungal and antibiotic drugs.
• diuretics (also known as “water pills”).
• cimetidine, used as a remedy for excess stomach acid.
• rifampicin, used to treat bacterial infections.

How to take KADIAN:

Take KADIAN

• exactly as prescribed
• generally every 24 hours unless otherwise instructed by your healthcare professional

KADIAN can be swallowed whole or sprinkled on applesauce or custard.

Swallowed:

• swallow the capsule whole
• take the capsule with a full glass of water
• do not cut, break, chew, dissolve or crush the capsule - this can be dangerous and life threatening

Sprinkled:

• measure a tablespoon of warm or cold (4° - 40°C) applesauce or room temperature custard
• open the capsule
• sprinkle contents onto the tablespoon
• ensure the capsule is emptied of all contents
• take the entire tablespoon as soon as possible
• do not chew the contents (beads)
• rinse your mouth and swallow the water
• do not keep any of the food/medicine mixture for another dose

If you do not remember when you sprinkled the medicine on the applesauce or custard, or which food you sprinkled the medicine on, throw out the food/medicine mixture.

Do not take a single dose greater than 20 mg of KADIAN every 24 hours unless you are “opioid tolerant”. Your healthcare professional will tell you when you are “opioid tolerant” to a certain dose of KADIAN.

KADIAN is not recommended for rectal administration.

Usual dose:

Dosage is individualized. Be sure to follow your healthcare professional’s dosing instructions exactly. Do not increase or decrease your dose without consulting your healthcare professional. Taking higher doses can lead to more side effects and a greater chance of overdose.

Review your pain regularly with your healthcare professional to determine if you still need KADIAN. Be sure to use KADIAN only for the condition for which it was prescribed.

Should your pain increase or any other complaint develop as a result of taking KADIAN, tell your healthcare professional immediately.

Stopping your Medication:

You should not stop taking KADIAN all at once if you have been taking it for more than a few days.

Your healthcare professional will monitor and guide you on how to slowly stop taking KADIAN. You should do it slowly to avoid uncomfortable symptoms such as having:

• body aches
• diarrhea
• goosebumps
• loss of appetite
• nausea
• feeling nervous or restless
• runny nose
• sneezing
• tremors or shivering
• stomach cramps
• rapid heart rate (tachycardia)
• having trouble with sleeping
• an unusual increase in sweating
• heart palpitations
• an unexplained fever
• weakness
• yawning

By reducing or stopping your opioid treatment, your body will become less used to opioids. If you start treatment again, you will need to start at the lowest dose. You may overdose if you restart at the last dose you took before you slowly stopped taking KADIAN.

Refilling Prescriptions for KADIAN:

A new written prescription is required from your healthcare professional each time you need more KADIAN. Therefore, it is important that you contact your healthcare professional before your current supply runs out.

Only obtain prescriptions for this medicine from the healthcare professional in charge of your treatment. Do not seek prescriptions from other healthcare professionals unless you switch to another healthcare professional for your pain management.

Overdose:

Signs of overdose may include:

• unusually slow or weak breathing
• dizziness
• confusion
• extreme drowsiness
• low blood sugar (dizziness, lack of energy, drowsiness, headache, trembling, sweating)

Missed dose:

It is important that you do not miss any doses. If you miss a dose, take your next dose at your usual time. You should always try to get back on track with your regular dosing schedule (for example, 8 o’clock in the morning or 8 o’clock in the evening). If you miss several doses in a row, talk to your healthcare professional before restarting your medication. Do not take a double dose to make up for a missed dose.

Possible side effects from using KADIAN:

These are not all the possible side effects you may have when taking KADIAN. If you experience any side effects not listed here, tell your healthcare professional.

Side effects may include:

• confusion
• constipation
• dizziness
• drowsiness
• light-headedness
• insomnia
• nausea, vomiting, poor appetite, dry mouth
• headache
• problems with vision
• weakness (lack of muscle strength), uncoordinated muscle movement
• itching
• sweating
• difficulty in urinating
• low sex drive, impotence (erectile dysfunction), infertility.

Talk with your healthcare professional about ways to prevent constipation when you start using KADIAN.

Serious side effects and what to do about them

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, tell your healthcare professional.

Reporting side effects

Storage:

• Store at room temperature (15° - 25°C). Keep in a dry place.
• Keep unused or expired KADIAN in a secure place to prevent theft, misuse or accidental exposure.
• Keep KADIAN under lock, out of sight and reach of children and pets.
• Never take medicine in front of small children as they will want to copy you. Accidental ingestion by a child is dangerous and may result in death. If a child accidentally takes KADIAN, get emergency help right away.

Disposal:

Never throw KADIAN into household trash, where children and pets may find it. Return any unused or expired medication to a pharmacy for proper disposal.

If you want more information about KADIAN:

• Talk to your healthcare professional
• Find the full Product Monograph that is prepared for healthcare professionals and includes the Patient Medication Information by visiting the Health Canada Drug Product Database website (https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html); the manufacturer’s website www.viatris.ca; or by calling 1-844-596-9526.

Date of Authorization: 2026-08-20

®Registered trademark of BGP Pharma ULC, Etobicoke, Ontario, M8Z 2S6.