Compounding of preservative-free high-concentration morphine sulfate injection

The compounding of a preservative-free high-concentration morphine sulfate injection from nonsterile morphine sulfate is described. High-concentration (50 mg/mL) morphine sulfate injection is compounded by dissolving Morphine Sulfate Powder, USP, in preservative-free sterile water for injection. The solution is pumped through 0.8- and 0.22-micrometer filters into 10-mL sterile vials and quarantined until assays for concentration, sterility, and bacterial endotoxins have been performed. The solution is placed in active inventory and dispensed to nursing units as needed. Total compounding cost per 10-mL vial of morphine sulfate injection is about $9. The expiration date is six months from the date of compounding. This solution has been administered i.m., s.c., i.v., and epidurally to inpatients with advanced cancer and severe pain at an acute care hospital. An acute care hospital compounds batches of preservative-free high-concentration morphine sulfate injection from nonsterile morphine sulfate.