Drugs List

Therapeutic Indications

Uses

Relief of symptoms of diarrhoea and upset stomachs.

Contraindications

Intestinal obstruction
Children under 5 years
Metabolic or respiratory alkalosis
Hypocalcaemia
Hypochlorhydria

Due to the morphine content some manufacturers also contraindicate kaolin and morphine mixture on theoretical grounds in patients with the following conditions:
Raised intracranial pressure or head injury
Respiratory depression
Hepatic impairment
Alcoholism
Obstructive airways disease
Convulsive disorders

Precautions and Warnings

Kaolin and morphine mixture contains sodium bicarbonate. Use with caution in patients with congestive heart failure, renal impairment, cirrhosis of the liver and hypertension.

Due to the morphine content of the product, some manufacturers advise to use with caution in patients with hypothyroidism, prostatic hypertrophy, in patients with reduced respiratory reserve and also in the elderly.

Use with caution in patients with inflammatory or obstructive bowel disorders.

Patients should be advised to consult a doctor if symptoms persist for more than 24 hours.

Ensure adequate hydration is maintained. Drink plenty of fluids during diarrhoeal episodes.

May cause drowsiness. If affected do not drive or operate machinery.

Prolonged use of morphine containing products may lead to tolerance and dependence.

Not all brands are licensed for children under 12 years.

Pregnancy and Lactation

Pregnancy

Safety has not been established but no special precautions are necessary if the dosage is followed.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Safety has not been established but no special precautions are necessary if the dosage is followed.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Flatulence
Stomach cramps

Morphine (whilst only present in low concentration in kaolin and morphine mixture) may theoretically cause nausea, vomiting, constipation, drowsiness and confusion. Prolonged use may lead to tolerance and dependence.

Presentation

Mixture containing light kaolin 20%, sodium bicarbonate 5%, and chloroform and morphine tincture 4%

Drugs List

Therapeutic Indications

Uses

Relief of symptoms of diarrhoea and upset stomachs.

Dosage

Adults

Elderly

Children

Contraindications

Intestinal obstruction
Children under 5 years
Metabolic or respiratory alkalosis
Hypocalcaemia
Hypochlorhydria

Due to the morphine content some manufacturers also contraindicate kaolin and morphine mixture on theoretical grounds in patients with the following conditions:
Raised intracranial pressure or head injury
Respiratory depression
Hepatic impairment
Alcoholism
Obstructive airways disease
Convulsive disorders

Precautions and Warnings

Kaolin and morphine mixture contains sodium bicarbonate. Use with caution in patients with congestive heart failure, renal impairment, cirrhosis of the liver and hypertension.

Due to the morphine content of the product, some manufacturers advise to use with caution in patients with hypothyroidism, prostatic hypertrophy, in patients with reduced respiratory reserve and also in the elderly.

Use with caution in patients with inflammatory or obstructive bowel disorders.

Patients should be advised to consult a doctor if symptoms persist for more than 24 hours.

Ensure adequate hydration is maintained. Drink plenty of fluids during diarrhoeal episodes.

May cause drowsiness. If affected do not drive or operate machinery.

Prolonged use of morphine containing products may lead to tolerance and dependence.

Not all brands are licensed for children under 12 years.

Pregnancy and Lactation

Pregnancy

Safety has not been established but no special precautions are necessary if the dosage is followed.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Safety has not been established but no special precautions are necessary if the dosage is followed.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Effects on Ability to Drive and Operate Machinery

This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988 (England and Wales). This medicine may be subject to police testing and has specified maximum blood levels for driving. When prescribing this medicine: Advise patient the medicine can affect cognitive function and is likely to affect ability to drive. Advise patient not to drive until they know how the medicine affects them. It is an offence to drive while under the influence of this medicine. However, a patient is not committing an offence (called 'statutory defence') if: 1.The medicine has been prescribed to treat a medical or dental problem and 2.The medicine has been taken according to the instructions given by the prescriber and/or in the information provided with the medicine and 3.The medicine was not affecting the ability to drive safely. For further guidance see https://www.gov.uk

Counselling

Advise patients that some side effects may effect the patients ability to drive or operate machinery.

Patients should be advised to consult a doctor if symptoms persist for more than 24 hours.

Patients should be advised to replace the body fluids lost during diarrhoea.

Side Effects

Flatulence
Stomach cramps

Morphine (whilst only present in low concentration in kaolin and morphine mixture) may theoretically cause nausea, vomiting, constipation, drowsiness and confusion. Prolonged use may lead to tolerance and dependence.

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Shelf Life and Storage

Store below 25 degrees C.

Keep container tightly closed

Further Information

Last Full Review Date: March 2011

Reference Sources

British National Formulary, 60th Edition (2010) Pharmaceutical Press, London.

Summary of Product Characteristics: Kaolin and Morphine Mixture BP. The Boots Company PLC. Revised January 2010.

Summary of product characteristics: Kaolin and Morphine Mixture BP. L.C.M Ltd. Revised July 2004.

Gov.uk. Government departments. Department for Transport. Publications. Drug driving and medicine: advice for healthcare professionals. Drug driving: Guidance for healthcare professionals on drug driving. Available at: https://www.gov.uk Last accessed: 6 January 2015