Different Concentration and Formulation in Different Batches of Oral Morphine Syrup and other Medications
Ministry of HealthSpeakers
Summary
This question concerns the procurement of oral morphine syrup with varying concentrations and ethanol content for patients requiring pain and breathlessness management. Dr Tan Wu Meng inquired about the reasons for these formulation changes, risk mitigation for home caregivers, and access to ethanol-free alternatives. Minister for Health Ong Ye Kung explained that the 2019 discontinuation of the original product necessitated sourcing an ethanol-containing alternative until a non-ethanol version was recently acquired. He highlighted that each preparation is clearly labeled with dosage instructions and that healthcare professionals educate caregivers to prevent medication errors during formulation switches. Additionally, doctors are advised to offer non-alcohol based medications to patients who prefer or require ethanol-free alternatives.
Transcript
75 Dr Tan Wu Meng asked the Minister for Health with regard to oral morphine syrup used to treat patients with pain and breathlessness (a) why have certain batches been procured with different concentration and formulation containing 10% ethanol; (b) what is done to minimise error risk from different medication concentrations especially when administered by care-givers at home; and (c) for patients uncomfortable with ethanol-containing medication, what has been done to help patients access ethanol-free alternatives.
Mr Ong Ye Kung: The only registered Oral Morphine one milligram per millilitre (1mg/ml) Syrup (Statex) in Singapore was discontinued in 2019 as the plant ceased manufacturing the product. The Agency for Logistics and Procurement Services (ALPS) then brought in Oramorph 2mg/mL syrup, which contains Ethanol, for use in public healthcare institutions (PHIs). This was the only alternative that we were able to source for at that time.
Doctors were advised to offer non-alcohol based medications with the same analgesic effect instead of oral morphine solutions for their patients who could not take ethanol containing medication. ALPS has since procured a non-ethanol containing morphine syrup, Ra-morph 1 mg/ml preparation for the PHIs.
Each preparation is clearly labelled with the formulation and dosage instructions. Doctors, pharmacists and nurses work together to educate patients and caregivers on the differences in the medications and help them to switch from one formulation to another, when necessary.