Morphine Sulphate

Narcotic Analgesic · Opioid analgesic

Indications

Inj: Acute and chronic severe pain. Tab: Prolonged relief of severe pain.

Dosage

INJECTION: Adults: IV: Initial: 2-10 mg/70 kg. Epidural: Initial: 5 mg in lumbar region, increase by 1-2 mg if needed. Max: 10 mg/24 hr. Continuous epidural: Initial: 2-4 mg/24 hr, give additional 1-2 mg if needed. Max: 10 mg/24 hr. Intrathecal: 0.2-1 mg single inj. Adults: Conversion from oral morphine: Give total daily morphine dose as a single dose every 24 hr. Conversion from parenteral morphine: Initial: Give about 3 x previous daily parenteral morphine requirement. Conversion from other parenteral or oral non-morphine opioid: Initial: Give 1/2 of estimated daily morphine requirement every 24 hr. May supplement with immediate-release morphine or short-acting analgesics. Titrate: Adjust as frequently as once daily. Non-opioid tolerant: 30 mg every 24 hr. Titrate: Increase by no more than 30 mg every 4 day. Max: 1600 mg/day. Children: Not recommended. ORAL: Adults: Initially 10 mg or…

Administration

IV: Inject 2.5 to 15 mg directly into tubing of free-flowing IV solution over 4 to 5 mins. Rapid IV injection may increase adverse reactions. Reconstitution: When giving morphine IV push, it is best to first dilute in 4-5 mL of SWFI. For continuous IV infusion, dilute drug in D5W and administer with infusion control device. Adjust dose and rate based on patient's response, as prescribed. Compatibility: Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D5 1/4NS, D5 1/2 NS, D5NS, D5W, D10W, LR, 1/2NS, NS. Y-site administration: Drug to Drug IV Compatibility: Amikacin, amiodarone, aztreonam, bumetanide, calcium gluconate, cephazolin, ceftriaxone, cimetidine, cisatracurium, dexamethasone, digoxin, diltiazem, diphenhydramine, dobutamine, dopamine, enalapril, epinephrine, esmolol, famotidine, fentanyl, fluconazole, gentamicin, hydromorphone, imipenem, ketorolac, levofloxacin,…

Adverse Effects

Tolerance, dependence, constipation, nausea, vomiting, drowsiness, confusion, urticaria, pruritus, respiratory depression, GI upset, dry mouth, headache, dizziness, hallucination, mood changes, miosis, rash, sweating.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Caution advised or effect undetermined. Contraindications: Respiratory depression, obstructive airways disease, acute hepatic disease, paralytic ileus, heart failure secondary to lung disease, acute abdomen, biliary obstruction, following biliary surgery, 24 hrs before cordotomy, delayed gastric emptying, acute alcoholism, raised intracranial pressure, head injury, coma, convulsive disorders, phaeochromocytoma. Sustained release preparation; pre-op and 24-hour post-op use. Precautions: Hypothyroidism, renal or hepatic impairment, hypotension, asthma, hypovolaemia, biliary tract disease, pancreatitis, inflammatory bowel disease, prostatic hypertrophy, adrenocortical insufficiency, reduced respiratory reserve, convulsive disorders, shock, sickle cell disease, surgery. Elderly.…

Interactions

MAOIs, CNS depressants, cimetidine, TCADs, opioid antagonists, rifampicin, muscle relaxants, antihypertensives, gabapentin, voriconazole, ritonavir, domperidone, metoclopramide, mexiletine.

Advice to Patient

Take with or without meals. To reduce GI upset, take with meals. To improve taste of oral solution, mix it with juice. Do not chew, crush or break controlled release tablets. If you have difficulty in swallowing, open extended release capsules and pour contents on food or liquid. Take medication immediately and do not let capsule contents dissolve in mouth. If constipation is unrelieved in few days, consult prescriber for suitable laxative or stool-softener. Contact prescriber if there is constant headache, acute dizziness, light-headedness, slow or fast heartbeat, chest pain, unusual weight gain, swelling of extremities, changes in mental status, changes in urinary pattern, pain on urination, back pain, muscle spasm, difficulty in breathing, skin rash, blurred vision, decrease in appetite. Avoid alcohol during therapy. Do not take OTC medications especially tranquilizers, sedatives,…

Pharmacokinetics

Onset of action: (Patient dependent; dosing must be individualized): Oral (immediate release): Approx. 30 mins; IV: 5-10 mins. Duration: (Patient dependent; dosing must be individualized): Pain relief: Immediate-release formulations (tab, oral soln, inj): 3-5 hrs. Extended-release cap and tab: 8-24 hrs (formulation dependent). Epidural or intrathecal: Single dose: Up to 24 hrs. Suppository: 3-7 hrs. Absorption: Variable. Metabolism: Hepatic. Bioavailability: Oral: 17%-33%. Nebulization: 5.5 ± 3.2%. Half-life elimination: Preterm: 10-20 hrs. Neonates: 7.6 hrs. Infants 1-3 mths: Median: 6.2 hrs. Infants 3-6 mths: Median: 4.5 hrs. Infants 6 mths-Children 2.5 yrs: Median: 2.9 hrs. Preschool Children: 1-2 hrs. Children with sickle cell disease (age 6-19 yrs): Approx. 1.3 hrs. Adults: Immediate-release forms: 2-4 hrs. Time to peak: Plasma: Tabs, oral soln, epidural: 1 hr. Extended release…

Brands with this active ingredient

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