Molecular structure of morphine
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Avinza

Morphine (INN), the principal active agent in opium, is a powerful opioid analgesic drug. Like other opiates, morphine acts directly on the central nervous system (CNS) to relieve pain, and at synapses of the arcuate nucleus, in particular. Side effects include impairment of mental performance, euphoria, drowsiness, lethargy, and blurred vision. It also decreases hunger, inhibits the cough reflex, and produces constipation. Morphine is usually highly addictive, and tolerance and physical and psychological dependence develop quickly. more...

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Patients on morphine often report insomnia and nightmares.

The word derives from Morpheus, the god of dreams in Greek mythology.

Medical use

Administration

Morphine may be given parenterally as subcutaneous, intravenous, or epidural injections. The military sometimes issues morphine loaded in an autoinjector. Morphine can also be administered through a slow-release transdermal patch.

Orally, it comes as an elixir, concentrated solution, powder (for compounding) or in tablet form. Morphine is rarely supplied in suppository form. Due to its poor oral bioavailability, oral morphine is only one-sixth to one-third of the potency of parenteral morphine. Morphine is available in extended-release capsules for chronic administration, as well as immediate-release formulations.

Uses

Morphine is used legally:

  • analgesic in hospital settings for
    • Pain after surgery
    • Pain associated with trauma
  • In the relief of moderate to severe chronic pain
    • Cancer pain
    • Tooth extraction
  • As an adjunct to general anesthesia
  • In epidural anesthesia
  • For palliative care (i.e. to alleviate pain without curing the underlying reason for it)
  • As an antitussive for severe cough
  • As an antidiarrheal in chronic conditions (e.g., for diarrhea associated with AIDS)

Contraindications

  • Acute pancreatitis (this may be a result of morphine use as well)
  • Renal failure (due to accumulation of the metabolite morphine-6-glucuronide)

Pharmacology

Morphine is an opioid agonist whose main effect is binding to the µ-receptors in the central nervous system. This is thought to be the reason behind the analgesia, euphoria, physical dependence and respiratory depression. Morphine also binds with k-receptors, which are thought to mediate spinal analgesia, miosis and sedation.

Legal classification

  • In the United Kingdom, morphine is listed as a Class A drug under the Misuse of Drugs Act 1971.
  • In the United States, morphine is classified as a Schedule II drug under the Controlled Substances Act.
  • Internationally, morphine is a Schedule I drug under the Single Convention on Narcotic Drugs.

History

Morphine was first isolated in 1804 by the German pharmacist Friedrich Wilhelm Adam Sertürner, who named it "morphium" after Morpheus, the Greek god of dreams. But it was not until the development of the hypodermic needle (1853) that its use spread. It was used for pain relief, and as a "cure" for opium and alcohol addiction. Its extensive use during the American Civil War resulted in over 400,000 sufferers from the "soldier's disease" (addiction), though some believe this to be erroneous .

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Ligand and Organon Announce Expansion of Sales Calls to Primary Care Physicians and Long-Term Care/Hospice Market to Accelerate AVINZA Growth
From Business Wire, 3/31/04

Business Editors/Health/Medical Writers

BIOWIRE2K

SAN DIEGO--(BUSINESS WIRE)--March 31, 2004

New Five-Year Rx Market Share Target of 15% Established

Ligand (Nasdaq:LGND) and Organon today announced plans to expand their combined AVINZA primary care sales force calls by more than 50 percent and to establish a specific targeted sales force effort to cover the large growing long-term care/hospice segment of the rapidly growing $3.6 billion sustained-release opioid (SRO) chronic moderate-to-severe pain market. These plans were outlined at Ligand's 4th Annual Investor and Analyst Day meeting in New York City on March 31 at the Regency Hotel, where both managements provided updates on AVINZA(R) (morphine sulfate extended-release capsules) performance in 2003, the size of the future AVINZA opportunity, and their plans to further accelerate AVINZA market share penetration.

"AVINZA performed well in 2003 in both prescription market share growth and net sales as a result of rapid adoption by pain specialists and opinion leaders and early progress with primary care physicians," commented David E. Robinson, Ligand's president and CEO. "However, the opportunity in primary care representing more than half of all SRO prescriptions and in long-term care and hospice estimated at 15-20 percent of the value market remains to be more fully developed. It is the overall growth opportunity of AVINZA and in these particular segments which has motivated the partners to announce plans to expand AVINZA sales force calls and to increase the year-end five-year market share target of AVINZA to 15 percent of overall SRO prescriptions."

AVINZA Primary Care (PCP) Sales Force Calls to Increase 50 Percent and Specific Sales Force Effort Targeting Long-Term Care/Hospice Segment Initiated

The AVINZA co-promotion partners outlined their plans to expand primary care physician reach and frequency through an increase in AVINZA sales force calls by Organon (additional focus of existing sales force efforts) and an expansion of Ligand's specialty sales force by 36 representatives (from current 70 to 106) calling upon top decile PCPs in a mirrored activity to Organon's representatives. Through these activities, the partners expect to achieve a 50 percent or more increase in overall calls and a reach and frequency more comparable to the partners' pain specialty sales forces' reach and frequency. The expansion of PCP sales force calls is timely, as traditionally market leaders may be inclined to reduce sales force efforts on brands as generics enter the market and compete through substitution at pharmacy for their business.

The AVINZA long-term care/hospice focused efforts will be achieved through an additional focus of the Organon hospital sales force and a specific call plan on key long-term care and hospice physicians and pain treatment staff. This segment of the market represents an estimated $600 million opportunity of the $3.6 billion SRO market in which AVINZA has only minimally participated. The advantages of a once-a-day oral SRO are particularly well suited to many patients confined to chronic pain treatment in long-term care and hospice settings.

"We believe that expanding PCP reach and frequency and long-term care/hospice coverage while maintaining strong specialty coverage over the next several years provides the partners with the best opportunity to accelerate AVINZA market share penetration and its contribution to our shareholders," said Robinson. "While we have increased our long-term AVINZA share target and expect these sales force actions to be first full year accretive, we are not altering our 2004 expense, revenue, or EPS guidance ranges at this time, but will monitor our overall progress in implementation and the market response and provide further updates in our quarterly results discussion as appropriate throughout the year."

About AVINZA

In March 2002, the U.S. Food and Drug Administration granted marketing approval for AVINZA for the once-daily treatment of moderate-to-severe pain in patients who require continuous, around-the-clock opioid therapy for an extended period of time. Ligand launched the product in mid-2002. Organon Pharmaceuticals USA Inc. began full co-promotion of AVINZA with Ligand in March of 2003.

Full prescribing information for AVINZA may be obtained in the United States from Ligand Professional Services by calling toll free 800-964-5836 or on Ligand's web site at http://www.ligand.com.

About Ligand

Ligand discovers, develops and markets new drugs that address critical unmet medical needs of patients in the areas of cancer, pain, skin diseases, men's and women's hormone-related diseases, osteoporosis, metabolic disorders, and cardiovascular and inflammatory diseases. Ligand's proprietary drug discovery and development programs are based on its leadership position in gene transcription technology, primarily related to Intracellular Receptors (IRs) and Signal Transducers and Activators of Transcription (STATs). For more information, go to http://www.ligand.com.

About Organon

Organon Pharmaceuticals USA Inc., headquartered in Roseland, NJ, is the U.S. affiliate of Organon International Inc., a renowned ethical pharmaceutical company. Organon maintains a strong commitment to health care, conducting research in the areas of psychiatry, contraception, fertility, anesthesiology, thrombosis, immunology, osteoporosis prevention and treatment of post-menopausal symptoms.

Organon is one of the business units of Akzo Nobel. Headquartered in The Netherlands, Akzo Nobel N.V. (NASDAQ:AKZOY) is a market-driven and technology-based company, serving customers throughout the world with health care products, coating and chemicals. Consolidated sales for 2003 totaled EUR 13 billion. The company currently employs over 64,500 people in more than 80 countries.

Caution Regarding Forward-Looking Statements

This news release contains certain forward-looking statements by Ligand and Organon that involve risks and uncertainties and reflect the companies' judgment as of the date of this release. These statements include those related to co-promotion and sales efforts, market size, market share, stocking and prescription growth; product potential, acceptance and success; share of voice and the ability to increase the number of sales representatives. Actual events or results may differ from the companies' expectations. For example, there can be no assurance that the expanded co-promotion efforts will be successful or that AVINZA sales will meet expectations. Additional information concerning these and other risk factors affecting Ligand's and Organon's businesses can be found in prior press releases as well as in the companies' public periodic filings with the Securities and Exchange Commission, available via the companies' respective internet sites. Ligand and Organon disclaim any intent or obligation to update these forward-looking statements beyond the date of this release. This caution is made under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

COPYRIGHT 2004 Business Wire
COPYRIGHT 2004 Gale Group

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