Morphine Sulphate

Indications & Dose:

To relieve acute or chronic moderate to severe pain; as adjunct to treat pulmonary edema caused by left-sided heart failure; to supplement general, local, or regional anesthesia.

• BY MOUTH

Adults. Initial: 10 to 30 mg every 4 hr, p.r.n.

Children: Individualized dosage base on patient’s age, size, and need.

• I.V. INFUSION

Adults.

Initial: 15 mg (or more) followed by 0.8 to 10 mg/ hr, increased as needed for effectiveness. Maintenance: 0.8 to 80 mg/hr.

Children.

0.01 to 0.04 mg/kg/hr postoperatively, 0.025 to 2.6 mg/kg/hr for severe chronic cancer pain, or 0.03 to 0.15 mg/kg/hr for sickle cell crisis.

Neonates.

Initial: 0.010 mg/kg/hr (10 mcg/ kg/hr) postoperatively.

Maintenance: 0.015 to 0.02 mg/ kg/hr (15 to 20 mcg/kg/hr).

I.V. INJECTION

Adults. 2.5 to 15 mg injected slowly.

Children. 0.5 to 0.1 mg/kg given slowly.

I.M. OR SUBSCUTANEOUS INJECTION

Adults.

Initial: 10 mg (based on 70-kg [154-lb] every 4 hr. Maintenance: 5 to 20 mg.

Children:

Initial: 0.1 to 0.2 mg/kg every 4 hr. Maximum: 15 mg/dose.

EPIDURAL INFUSION (PRESERVATIVE-FREE)

Adults.

Initial: 2 to 4 mg/24 hr, increased by 1 to 2 mg/24 hr, as directed.

EPIDURAL INJECTION (PRESERVATIVE-FREE)

Adults.

Initial: 5 mg into lumbar region. If pain isn’t relieved after 1 hr, 1 - to 2-mg doses given at appropriate intervals to relieve pain. Maximum: 10 mg/24hr.

I.V. INJECTION

Adults.

1 to 4 mg by slow I.V. injection. Repeated up to every 5 min, if needed.

Maximum: 2 to 15 mg. to provide preoperative analgesia

I.M. OR SUBSUTANEOUS INJECTION

Adults.

5 to 20 mg given 45 to 60 min before surgery.

Children. 0.05 to 0.1 mg/kg given 45 to 60 min before surgery.

Maximum: 10 mg.

To provide analgesia during labor

I.M. OR SUBCUTANEOUS INJECTION

Adults.

10 mg, with subsequent doses based on patient’s response

Contraindications:

Respiratory depression, obstructive airways disease, known morphine sensitivity, acute hepatic disease, concurrent administration of monoamine oxidase inhibitors. Morphine Sulphate is not recommended for paediatric use or in pregnancy. Preoperative administration of Morphine Sulphate is not recommended and is not an approved indication. 

Side Effects:

Cautions:

Precautions:

As with all narcotics a reduction in dosage may be advisable in the elderly, in hypothyroidism, in renal and chronic hepatic disease.

Pregnancy:

In humans, it is not known whether morphine can cause fetal harm when administered during pregnancy or can affect reproductive capacity. Morphine Sulphate should be given to pregnant patients only if clearly needed and when the anticipated benefits out weigh the risks to the fetus. 

Interaction:

DRUGS

amitriptyline, clomipramine, nortriptyline: Increased CNS and respiratory depression

anticholinergics: Possibly severe constipa-tion leading to ileus, urine retention antidiarrheals (such as loperamide and paregoric): CNS depression, possibly severe constipation

antihistamines, chloral hydrate, glutethimide, MAO inhibitors, methocarbamol: Increased CNS and respiratory depressant effects antihypertensives, hypotension-producing drugs: Increased hypotension, risk of orthostatic hypotension bupivacaine: Increased serum morphine level and possibly significant adverse effects buprenorphine: Decreased therapeutic effects of morphine, increased respiratory depression, possibly withdrawal symptoms cimetidine: Increased analgesic and CNS and respiratory depressant effects CNS depressants (antiemetics, general anes-thetics, hypnotics, phenothiazines, sedatives, tranquilizers): Possibly coma, hypotension, respiratory depression, severe sedation diuretics: Decreased diuretic efficacy hydroxyzine: Increased analgesic, CNS depressant, and hypotensive effects of morphine metodopramide: Possibly antagonized metoclopramide effect on GI motility mixed agonist-antagonist analgesics: Possibly withdrawal symptoms naloxone: Antagonized analgesic and CNS and respiratory depressant effects of mor-phine, possibly withdrawal symptoms naltrexone: Possibly induction or worsening of withdrawal symptoms if morphine given within 7 to 10 days before naltrexone neuromuscular blockers: Increased or prolonged respiratory depression opioid analgesics (such as alfentanil and sufentanil): Increased CNS and respiratory depression, increased hypotension zidovudine: Decreased zidovudine clearance 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Agitation, amnesia, anxiety, ataxia, chills, coma, confusion, decreased concen-tration, delirium, delusions, depression, dizziness, dream abnormalities, drowsiness, edema, euphoria, fever, gait disturbance, hallucinations, headache, increased intracranial pressure, insomnia, lethargy, light-headedness, malaise, mood alterations, psychosis, restlessness, rigidity, sedation, seizures, syncope, thinking disturbances, thirst, tremor, unarousable, uncoordinated muscle movements, unresponsiveness, vertigo, weakness

CV: Bradycardia, cardiac arrest, edema, hypertension, hypotension, orthostatic hypotension, palpitations, shock, tachycardia, vasodilation

EENT: Amblyopia, blurred vision, diplopia, dry mouth, eye pain, hiccup, laryngeal edema or laryngospasm (allergic), miosis, nystagmus, rhinitis, taste or voice alteration

ENDO: Hypogonadism

GI: Abdominal cramps or pain, anorexia, biliary tract spasm, constipation, diarrhea, dysphagia, elevated liver function test results, gastroenteritis, gastroesophageal reflux, hiccups, ileus and toxic megacolon (in patients with inflammatory bowel dis-ease), intestinal obstruction, indigestion, nausea, vomiting

GU: Decreased ejaculate potency, decreased libido, difficult ejaculation, dysuria, impo-tence, menstrual irregularities, oliguria, prolonged labor, urinary hesitancy, urine retention

HEME: Anemia, leukopenia, thrombocyto-penia

MS: Arthralgia, decreased bone mineral density, skeletal muscle rigidity

RESP: Apnea, asthma exacerbation, atelectasis, bronchospasm, depressed cough reflex, hypoventilation, pulmonary edema, respiratory arrest and depression, wheezing

SKIN: Diaphoresis, dryness, flushing, pallor, pruritus, rash, urticaria

Other: Allergic reaction; anaphylaxis; facial edema; injection-site edema, pain, rash, or redness; physical and psychological depen-dence; weight loss; withdrawal symptoms 

Patient And Carer Advice: