Morphine


Generic Medicine Info
Indications and Dosage
Intramuscular, Subcutaneous
Premedication in surgery, Severe pain
Adult: As morphine sulfate: Usual dose: 10 mg 4 hourly (dose may vary from 5-20 mg) via IM or SC inj. Dosage is individualised based on the severity of pain, patient response, and prior analgesic experience.
Elderly: Dose reduction may be needed.

Intraspinal
Severe pain
Adult: As morphine sulfate: Initially, 5 mg via epidural inj, if desired pain relief is not achieved within 1 hour, incremental doses of 1-2 mg may be given up to a total dose of 10 mg/24 hours. As continuous epidural infusion: Initially, 3.5-7.5 mg daily in opioid-naïve patients or 4.5-10 mg daily for patients with some degree of opioid tolerance. Dosage is individualised based on the severity of pain, patient response, and prior analgesic experience. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Elderly: Initiate at the lower end of the dosing range.

Intrathecal
Severe pain
Adult: As morphine sulfate: Initially, 0.1-1 mg as a single dose for up to 24 hours. Dosage is individualised based on the severity of pain, patient response, and prior analgesic experience. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Elderly: Initiate at the lower end of the dosing range.

Intravenous
Premedication in surgery, Severe pain
Adult: As morphine sulfate: Initially, 2.5-15 mg 4 hourly via slow inj. Dosage is individualised based on the severity of pain, patient response, and prior analgesic experience. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Elderly: Dose reduction may be needed.

Oral
Moderate to severe pain
Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response, opioid tolerance, and prior analgesic experience. Use the lowest effective dose for the shortest treatment duration based on patient’s treatment goals. As conventional preparation: 5-20 mg 4 hourly. As extended-release tab/cap: Recommended initial dose: 10-30 mg 12-24 hourly.
Elderly: Dose reduction may be needed.

Rectal
Severe pain
Adult: As morphine sulfate supp: Initially, 10-20 mg 4 hourly. Dosage is individualised based on the severity of pain, patient response, and prior analgesic experience.
Elderly: Initiate at the lower end of the dosing range.
Renal Impairment
Oral:
Moderate to severe pain: Dose reduction may be needed.

Intravenous; Intramuscular; Subcutaneous:
Severe pain; Premedication in surgery: Dose reduction may be needed.
Hepatic Impairment
Oral:
Moderate to severe pain: Dose reduction may be needed.

Intravenous; Intramuscular; Subcutaneous:
Severe pain; Premedication in surgery: Dose reduction may be needed.
Administration
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Incompatibility
Aciclovir Na, aminophylline, tetracyclines, promethazine hydrochloride, ranitidine hydrochloride, furosemide, heparin Na, prochlorperazine edisilate, chlorpromazine hydrochloride, haloperidol, pethidine hydrochloride, doxorubicin, fluorouracil.
Contraindications
Hypersensitivity. Respiratory depression, acute or severe bronchial asthma, gastrointestinal obstruction (including paralytic ileus), suspected surgical abdomen, acute alcoholism, convulsive disorder, head injury, elevated intracranial or cerebrospinal pressure, brain tumour. Intrathecal: Infection at the microinfusion site, concomitant anticoagulant treatment, uncontrolled bleeding diathesis. Concomitant use or within 14 days of discontinuing MAOIs.
Special Precautions
Patient with CV disease (including acute MI), hypovolaemia, biliary tract dysfunction, acute pancreatitis, adrenal insufficiency including Addison disease, cor pulmonale, thyroid dysfunction, impaired respiratory function, decreased respiratory reserve, hypoxia, hypercarbia, seizure disorders, mental health condition (e.g. anxiety disorders, depression, PTSD), toxic psychosis, sleep-related disorders (including sleep apnoea), prostatic hyperplasia, urinary stricture, history of substance abuse disorder; delirium tremens. Obese and debilitated patients. Renal and severe hepatic impairment. Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: CNS depression, orthostatic hypotension, severe hypotension, syncope, opioid-induced constipation.
Cardiac disorders: Chest pain, arrhythmia, tachycardia.
Eye disorders: Blurred vision, miosis, nystagmus.
Gastrointestinal disorders: Nausea, vomiting, abdominal pain, dry mouth.
General disorders and administration site conditions: Asthenia, fatigue, malaise, chills, hypothermia, inj site pain and irritation, drug withdrawal (abstinence) syndrome.
Hepatobiliary disorders: Biliary spasm.
Metabolism and nutrition disorders: Anorexia, peripheral oedema.
Nervous system disorders: Headache, dizziness, drowsiness, somnolence, vertigo, convulsion, agitation, myoclonus, opioid-induced hyperalgesia, increased intracranial pressure.
Psychiatric disorders: Confusion, restlessness, mood swings, anxiety, insomnia, hallucination, disorientation, dysphoria, euphoria, tolerance and dependence (long-term use).
Renal and urinary disorders: Urinary retention.
Reproductive system and breast disorders: Decreased libido, erectile dysfunction, infertility (long-term use).
Respiratory, thoracic and mediastinal disorders: Bronchospasm.
Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria, angioedema, contact dermatitis, facial flushing, hyperhidrosis.
Potentially Fatal: Hypersensitivity, respiratory depression.
Epidural/IM/IT/IV/Parenteral/PO/Rectal/SC: C (Prolonged use may cause neonatal opioid withdrawal syndrome.)
Patient Counseling Information
This drug may cause CNS depression, if affected, do not drive or operate machinery.
Monitoring Parameters
Closely monitor respiratory status, mental status, blood pressure. Monitor for signs of misuse, abuse, and addiction. Monitor the efficacy of pain control. Monitor for signs of hypogonadism or hypoadrenalism.
Overdosage
Symptoms: Respiratory depression, pneumonia aspiration, pinpoint pupils, skeletal muscle flaccidity, hypotension, hypothermia, cold and clammy skin, bradycardia, somnolence, severe dizziness, severe drowsiness, hallucinations, convulsions (especially in infants and children), rhabdomyolysis leading to renal failure; circulatory failure, apnoea, CNS depression, stupor, coma, cardiac arrest. Management: Supportive treatment. Ensure adequate airway, ventilation and oxygenation. May administer opioid antagonist (e.g. naloxone) as an antidote.
Drug Interactions
Increased CNS depressant effect with other opioids, anxiolytics, sedatives, hypnotics (including benzodiazepines), muscle relaxants, antipsychotics, antidepressants (e.g. TCAs), general anaesthetics (including barbiturates), antiepileptics (e.g. pregabalin), gabapentin, antihypertensives, and centrally acting anti-emetics. Increased serum concentration with cimetidine. Decreased serum concentration with rifampicin, and ritonavir. May decrease the serum concentration of ciprofloxacin. Increased risk of severe constipation with antidiarrhoeal and antiperistaltic agents (e.g. loperamide, kaolin). May increase the anticoagulant effect of coumarin and other anti-coagulants. May delay absorption of mexiletine. May antagonise the gastrointestinal effect of metoclopramide, and domperidone. May decrease the therapeutic effect of diuretics.
Potentially Fatal: Enhanced CNS depressant effects with MAOIs.
Food Interaction
Increased bioavailability (oral) with food. Enhanced CNS depressant effect with alcohol.
Lab Interference
May interfere with gastric emptying studies and hepatobiliary imaging using technetium Tc99m diosfenin.
Action
Description:
Mechanism of Action: Morphine, a phenanthrene derivative, is an opioid analgesic that acts mainly on the CNS and smooth muscle. It binds to opioid receptors in the CNS causing a decrease in pain impulse transmission and altered pain perception and response.
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 (epidural or intrathecal).
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract (oral) and readily absorbed into the blood (SC/IM). Increased bioavailability (conventional preparations) with food. Bioavailability: 17-33% (oral). Time to peak plasma concentration: 1 hour (conventional preparation, epidural); 3-4 hours (extended-release tab); 20-60 minutes (supp); 50-90 minutes (SC); 30-60 minutes (IM); 20 minutes (IV).
Distribution: Distributed throughout the body mainly in the kidneys, lungs, liver, and spleen; lower concentration in the skeletal muscle and brain. Crosses the blood-brain barrier and placenta, enters breast milk. Volume of distribution: 1-6 L/kg. Plasma protein binding: 20-35%.
Metabolism: Metabolised in the liver and gut via conjugation with glucuronic acid into morphine-3-glucuronide and morphine-6-glucuronide; undergoes extensive first-pass metabolism.
Excretion: Via urine (approx 90% of total morphine); faeces (approx 10% as conjugates). Elimination half-life: 2-4 hours (immediate-release).
Chemical Structure

Chemical Structure Image
Morphine

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 5288826, Morphine. https://pubchem.ncbi.nlm.nih.gov/compound/Morphine. Accessed Aug. 16, 2023.

Storage
Tab/cap: Store between 15-30°C. Protect from light and moisture. Oral solution: Store below 30°C. Protect from light. Do not refrigerate. Inj/supp: Store between 20-25°C. Protect from light. Do not freeze. Storage recommendations may vary among individual products. Refer to specific product guidelines.
MIMS Class
Analgesics (Opioid)
ATC Classification
N02AA01 - morphine ; Belongs to the class of natural opium alkaloids. Used to relieve pain.
References
Actimorph 1 mg Orodispersible Tablets (Ethypharm). MHRA. https://products.mhra.gov.uk. Accessed 02/06/2023.

Anon. Morphine (Systemic) (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 01/06/2023.

Anon. Morphine (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 01/06/2023.

Anon. Morphine. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 01/06/2023.

Buckingham R (ed). Morphine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/06/2023.

Infumorph 200 and 500 Injection, Solution (Hikma Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/06/2023.

Joint Formulary Committee. Morphine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 01/06/2023.

Medicianz Healthcare Limited. Morphine Sulfate 2 mg/1 mL, 5 mg/1 mL, 10 mg/1 mL, 15 mg/1 mL, 30 mg/1 mL (Medsurge) Solution for Injection data sheet 26 July 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 01/06/2023.

Morfikaf (Kimia Farma). MIMS Indonesia. http://www.mims.com/indonesia. Accessed 07/06/2023.

Morphine Sulfate 10 mg/5 mL Oral Solution (Wockhardt UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 02/06/2023.

Morphine Sulfate 10 mg/mL Solution for Injection (AS KALCEKS). MHRA. https://products.mhra.gov.uk. Accessed 07/06/2023.

Morphine Sulfate Capsule, Extended Release (Amneal Pharmaceuticals of New York LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/06/2023.

Morphine Sulfate Injection, Solution (Hospira, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/06/2023.

Morphine Sulfate Solution (PAI Holdings, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/06/2023.

Morphine Sulfate Suppository (Bryant Ranch Prepack). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/06/2023.

Morphine Sulfate Tablet, Film Coated, Extended Release (Bryant Ranch Prepack). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 01/06/2023.

Morphine-Hamelin 10 mg/mL Injection, 1 mL (Imeks Pharma Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 01/06/2023.

Morphine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 07/06/2023.

MST Continus Tablets 30 mg (Mundipharma Pharmaceuticals Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 01/06/2023.

Multichem NZ Limited. M-Eslon SR, Modified Release Capsule, 10 mg, 30 mg, 60 mg, 100 mg and 200 mg data sheet 01 July 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 01/06/2023.

MXL 30 mg Prolonged Release Capsules (Napp Pharmaceuticals Ltd). MHRA. https://products.mhra.gov.uk. Accessed 02/06/2023.

Paediatric Formulary Committee. Morphine. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 01/06/2023.

Pfizer New Zealand Limited. Ra-Morph 1 mg/mL, 2 mg/mL, 5 mg/mL, 10 mg/mL Oral Solution data sheet 13 October 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 01/06/2023.

Pharmaco (N.Z.) Ltd. Sevredol 10 mg and 20 mg Tablets data sheet 16 December 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 01/06/2023.

Rhotard Morphine SR 60 mg Tablets; Morphgesic SR 60 mg Tablets (Amdipharm UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 02/06/2023.

Disclaimer: This information is independently developed by MIMS 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 MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS 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 © 2024 MIMS. All rights reserved. Powered by MIMS.com
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