Morphine


Full Prescribing Info
Dosage/Direction for Use

Oral
Moderate to severe pain
Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. As conventional preparation: 5-20 mg 4 hourly. As extended-release tab/cap: Recommended initial dose: 1 or 2 (10 mg) tab 12-24 hourly.
Child: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. As conventional preparation: 1-5 years
5 mg 4 hourly (Max: 30 mg daily); 6-12 years 5-10 mg 4 hourly (Max: 60 mg daily); <1>≥13 ears
Same as adult dose.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.

Parenteral
Severe pain
Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. Recommended dose: 10-20 mg 4-6 hourly (dose may vary from 5-20 mg) via SC, IM or IV inj.
Elderly: Dose reduction needed.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Parenteral
Acute pulmonary oedema

Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. Recommended dose: 10 mg 4 hourly if necessary (dose may vary from 5-20 mg) via SC or IM inj. May also be given via IV infusion at a dose corresponding to ¼ - ½ of the IM dose not more than 4 hourly.
Elderly: Dose reduction needed.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Parenteral
Premedication in surgery

Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. Recommended dose: 10 mg 4 hourly if necessary (dose may vary from 5-20 mg) via SC or IM inj. May also be given via IV infusion at a dose corresponding to ¼ - ½ of the IM dose not more than 4 hourly.
Elderly: Dose reduction needed.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Intravenous
Postoperative pain

Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. As Patient-Controlled Analgesia (PCA): Loading dose: 1-10 mg (Max 15 mg) via IV infusion over 4-5 minutes, then 1 mg on demand with 5-10 minutes lockout time.
Elderly: Dose reduction needed.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Intravenous
Pain associated with myocardial infarction

Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. As Patient-Controlled Analgesia (PCA): Loading dose: 1-10 mg (Max 15 mg) via IV infusion over 4-5 minutes, then 1 mg on demand with 5-10 minutes lockout time.
Elderly: Dose reduction needed.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Intravenous
Severe cancer pain

Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. As Patient-Controlled Analgesia (PCA): Loading dose: 1-10 mg (Max 15 mg) via IV infusion over 4-5 minutes, then 1 mg on demand with 5-10 minutes lockout time.
Elderly: Dose reduction needed.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Intravenous
Moderate to severe acute pain

Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. As Patient-Controlled Analgesia (PCA): Loading dose: 1-10 mg (Max 15 mg) via IV infusion over 4-5 minutes, then 1 mg on demand with 5-10 minutes lockout time.
Elderly: Dose reduction needed.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Parenteral
Severe pain

Adult: As morphine tartrate: 5-20 mg 4-6 hourly via SC/IM inj. If rapid onset of action is desired, may give 2.5-15 mg via slow IV inj over 4-5 minutes. As IV Patient-controlled analgesia (PCA): 1 mg/hour administered with a lockout interval of 6-10 minutes and 0.5 (Max of 1.5 mg) demand doses.
Child: As morphine tartrate: 0.1-0.2 mg/kg 4-6 hourly via SC/IM inj. Max dose: 15 mg. If rapid of onset is desired, 0.05-0.1 mg/kg via slow IV inj, may titrate dose incrementally over 5-15 minutes.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Parenteral
Severe cancer pain

Adult: As morphine tartrate: 5-20 mg 4-6 hourly via SC/IM inj. If rapid onset of action is desired, may give 2.5-15 mg via slow IV inj over 4-5 minutes. As IV Patient-controlled analgesia (PCA): 1 mg/hour administered with a lockout interval of 6-10 minutes and 0.5 (Max of 1.5 mg) demand doses.
Child: As morphine tartrate: 0.1-0.2 mg/kg 4-6 hourly via SC/IM inj. Max dose: 15 mg. If rapid of onset is desired, 0.05-0.1 mg/kg via slow IV inj, may titrate dose incrementally over 5-15 minutes.
Renal impairment: Dose reduction needed.
Hepatic impairment:
Dose reduction needed.
Incompatibility: Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Intraspinal
Moderate to severe pain
Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. Initially, 5 mg epidural inj, if desired pain relief is not achieved within 1 hour, incremental doses of 1-2 mg may be given up to 10 mg/24 hour.
Incompatibility:
Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Intrathecal
Moderate to severe pain
Adult: As morphine sulfate: 0.2-1 mg as single dose for up to 24 hours. Dosage is individualised based on the severity of pain, patient response and prior analgesic experience.
Incompatibility:
Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Intraspinal
Postoperative pain
Adult: As morphine sulfate liposomal inj: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. 10-20 mg for lumbar administration only depending on the type of surgery. Dose adjustments may be required according to individual response.
Incompatibility:
Aminophylline, amobarbital, chlorothiazide, phenytoin Na, heparin Na, meperidine HCl, methicillin Na, nitrofurantoin Na, pentobarbital Na, phenobarbital Na, Na bicarbonate, Na iodide, thiopental Na, Aciclovir Na, doxorubicin, fluorouracil, furosemide, haloperidol, pethidine HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline.

Rectal
Severe pain
Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. 10-20 mg 4 hourly.
Administration
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Contraindications
Hypersensitivity. Respiratory depression, obstructive airway disease, paralytic ileus, acute hepatic disease, acute alcoholism, head injuries, increased intracranial pressure, excessive bronchial secretions, acute or severe bronchial asthma, heart failure secondary to chronic lung disease, delayed gastric emptying, GI obstruction, acute abdomen, circulatory shock. Concomitant use during or within 14 days of MAOI therapy.
Special Precautions
Patient with hypovolaemia, CV disease (including acute MI), circulatory shock, adrenal insufficiency, Addison disease, biliary tract dysfunction, acute pancreatitis, delirium tremens, prostatic hyperplasia, urinary stricture, toxic psychosis, myasthenia gravis, mental health conditions (e.g. depression, anxiety, post-traumatic stress disorder), seizure, thyroid dysfunction, history of drug abuse or acute alcoholism, obese. Renal and severe hepatic impairment. Debilitated patients. Elderly. Pregnancy and lactation. Patient Counselling This drug may cause CNS depression, if affected, do not drive or operate machinery. Monitoring Parameters Monitor efficacy of pain control, vital signs, respiratory and mental status. Assess physical and/or psychological dependence. Monitor signs or symptoms of hypogonadism or hypoadrenalism.
Adverse Reactions
Significant: CNS depression, orthostatic hypotension, severe hypotension, syncope, constipation. Blood and lymphatic system disorders: Anaemia. Cardiac disorders: Bradycardia, palpitation, tachycardia. Eye disorder:Blurred or double vision, miosis. Gastrointestinal disorders: Abdominal pain, constipation, delayed gastric emptying, diarrhoea, dyspepsia, flatulence, nausea, vomiting, xerostomia, dry mouth, anorexia. General disorders and administration site conditions: Asthenic conditions, hyperhidrosis, withdrawal syndrome. Hepatobiliary disorders: Biliary colic, hypoesthesia, hypokalemia. Metabolism and nutrition disorders: Anorexia. Musculoskeletal and connective tissue disorders: Back pain. Nervous system disorders: Dizziness, headache, paresthesia, paralytic ileus, myoclonus. Psychiatric disorders: Anxiety, confusion, dependence, insomnia, hallucination, euphoria, agitation, mood altered. Renal and urinary disorders: Bladder spasm, oliguria, urinary retention. Reproductive system and breast disorders: Decreased libido or potency (long term use). Respiratory, thoracic and mediastinal disorders: Dyspnea, hypoxia, rigors, bronchospasm, pulmonary oedema. Skin and subcutaneous tissue disorders: Pruritus, skin rash, urticaria, sweating. Vascular disorders: Hypertension, facial flushing.
Potentially Fatal: Hypersensitivity. Respiratory depression.
C Prolonged use may cause neonatal opioid withdrawal syndrome (NOWS)
Overdosage
Symptoms: Respiratory depression, pinpoint pupils, hypoxia, hypothermia, severe dizziness, severe drowsiness, hypotension, bradycardia, circulatory failure pulmonary oedema, severe nervousness or restlessness, hallucinations, convulsion (especially in infants and children); skeletal muscle flaccidity, cold and clammy skin. Management: Ensure adequate airway, ventilation and oxygenation. Administration of opioid antagonist e.g. naloxone may be given as an antidote.
Drug Interactions
Increased depressant effects with/ other CNS depressants (e.g. sedatives, hypnotics, general anaesthesia, phenothiazines, tranquilisers). May enhance the neuromuscular blocking action of skeletal muscle relaxants. Reduced analgesic effect with mixed agonist/antagonist opioid analgesics (e.g. buprenorphine, nalbuphine, pentazocine). Increased plasma concentrations with cimetidine. Reduced plasma concentration with rifampicin, ritonavir. Decreased therapeutic effect of diuretics. Increased plasma concentration with cisapride. Increased risk of orthostatic hypotension with antihypertensive agents. Increased risk of severe constipation and CNS depression with antidiarrhoeal agents.
Potentially Fatal: Enhanced depressant effect with MAOIs.
Food Interaction
Alcohol enhances the CNS depressant effect of morphine. Increased bioavailability with food (oral).
Lab Interference
May interfere with gastric emptying studies and with hepatobiliary imaging using technetium Tc99m diosfenin.
Action
Morphine, an opioid analgesic, is a phenanthrene derivative which acts mainly on the CNS and smooth muscles. It binds to opiate receptors in the CNS altering pain perception and response by modulating the descending inhibitory pathways from the brain. Analgesia, euphoria and dependence are thought to be due to its action at the mc-1 receptors while respiratory depression and inhibition of intestinal movements are due to action at the mc-2 receptors. Spinal analgesia is mediated by morphine agonist action at the kappa-receptor.
Onset: Approx 30 minutes (conventional tab); 5-10 minutes (IV).
Duration: 3-5 hours (immediate-release); 8-24 hours (extended-release tab/cap); 3-7 hours (supp); Up to 24 hours (single dose epidural or intrathecal).
Absorption: Well absorbed from the gastrointestinal tract (oral) and into the blood (SC/IM). Increased bioavailability with food. Bioavailability: 17-33 % (oral). Time to peak plasma concentration: 1 hour (conventional tab, epidural); 3-4 hours (extended-release tab); 20-60 minutes (supp); 50-90 minutes (SC); 30-60 minutes (IM); 20 minutes (IV).
Distribution: Widely distributed throughout the body mainly in the kidneys, liver, lungs and spleen, with lower concentrations in the brain and muscles. Crosses the blood-brain barrier and placenta; enters breast milk. Volume of distribution: 1-6 L/kg. Plasma protein binding: Approx 35%.
Metabolism: Metabolised in the liver and gut via glucuronidation to produce morphine-3-glucoronide and morphine-6-glucoronide; undergoes extensive first-pass metabolism.
Excretion: Via urine [approx 60% (oral); approx 90% (pareteral)]; faeces (10%, as conjugates). Elimination half-life: Approx 2 hours (morphine); 2.4-6.7 hours (morphine-3-glucoronide).
Storage
Intraspinal: Store between 20-25°C. Protect from light and moisture. Intrathecal: Store between 20-25°C. Protect from light and moisture. Intravenous: Store between 20-25°C. Protect from light and moisture. Oral: Store between 20-25°C. Protect from light and moisture. Parenteral: Store between 20-25°C. Protect from light and moisture. Rectal: Store between 20-25°C. Protect from light and moisture.
CIMS Class
ATC Classification
N02AA01 - morphine ; Belongs to the class of natural opium alkaloids. Used to relieve pain.
Disclaimer: This information is independently developed by CIMS based on morphine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 CIMS. All rights reserved. Powered by CIMSAsia.com
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