Primary attention should be given to the establishment of a patent airway and institution of assisted or controlled ventillation.
Symptoms: Pinpoint pupils, respiratory depression, somnolence progressing to stupor and coma, skeletal muscle flaccidity, bradycardia, hypotension and death.
Crushing and taking the contents of a prolonged-release dosage form leads to the release of morphine in an immediate fashion; this might result in a fatal overdose.
Treatment: Administer naloxone 0.4 mg IV. Repeat at 2-min to 3-min intervals as necessary or by an infusion of 2 mg in 500 mL of normal saline or 5% dextrose (0.004 mg/mL).
The infusion should be run at a rate related to the previous bolus doses administered and should be in accordance to the patient's response. Empty the stomach. A 0.02% aqueous solution of potassium permanganate may be used for lavage. Assist respiration if necessary. Maintain fluid and electrolyte levels. In the case of MST Continus tablets, the physician should be aware that tablets remaining in the intestine will continue to release morphine sulfate and add to the morphine load for up to 12 hrs after administration and the management of morphine overdosage should be modified accordingly.