What is morphine?
Morphine is an opioid medication. An opioid is sometimes called a narcotic. Morphine works by blocking pain signals from travelling along the nerves to the brain.
Morphine is used to treat moderate to severe pain. The extended-release form of morphine is for around-the-clock treatment of pain. Short-acting formulations are taken as needed for pain.
Usual Adult Dose for Pain
Individualize dosing regimen taking into account severity of pain, response to therapy, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse:
ORAL:
Immediate-release (IR):
OPIOID-NAIVE and OPIOID NON-TOLERANT:
-IR tablets: Initial dose: 15 to 30 mg orally every 4 hours as needed to manage pain.
-IR oral solution: Initial dose: 10 to 20 mg orally every 4 hours as needed to manage pain.
TITRATION AND MAINTENANCE: Individually titrate to a dose that provides an appropriate balance between pain management and opioid-related adverse reactions.
IMPORTANT NOTE: Oral solution is available in 3 concentrations 2 mg/mL, 4 mg/mL, and 20 mg/mL; reserve use of 20 mg/mL concentration for patients who are opioid-tolerant.
PARENTERAL:
IV: 0.1 mg to 0.2 mg/kg via slow IV injection every 4 hours as needed to manage pain; alternatively, 2 to 10 mg IV (based on 70 kg adult).
IM: 10 mg IM every 4 hours as needed to manage pain (based on 70 kg adult).
TITRATION AND MAINTENANCE: Individually titrate to a dose that provides an appropriate balance between pain management and opioid-related adverse reactions.
IMPORTANT NOTE: IM administration is not the recommended route of administration due to its painful administration, wide fluctuations in muscle absorption, 30 to 60-minute lag to peak effect, and rapid fall off of action compared to oral administration.
CONVERSION from Parenteral to Oral Morphine:
-Between 3 and 6 mg of oral morphine provides pain relief equivalent to 1 mg of parenteral morphine.
PATIENT CONTROLLED ANALGESIA (PCA): For use in a compatible infusion device; patient must be closely monitored because of the considerable variability in both dose requirements and patient response. Mean morphine self-administration rate during clinical trials was 1 to 10 mg/hour during clinical trials. The following is provided as guidance; doses should be individualized:
–Loading dose: 2.5 mg.
–Demand dose: 0.5 to 2 mg.
–Lockout: 10-minute.
Maximum Dosing: Opioid Naive: 10 mg/hour; Opioid Tolerant: 30 mg/hour, although greater rates may be needed in select patients.
Epidural Administration:
-Initial dose: 5 mg in the lumbar region may provide satisfactory pain relief for up to 24 hours.
-If adequate pain relief is not achieved within 1 hour, doses of 1 to 2 mg may be given at intervals sufficient to assess the effectiveness
Maximum dose: 10 mg per 24 hours.
Intrathecal Administration: Dosage is usually one-tenth that of epidural dosage.
-Initial dose: 0.2 to 1 mg may provide satisfactory pain relief for up to 24 hours.
-Repeated intrathecal injections are not recommended.
-A constant intravenous infusion of naloxone 0.6 mg/hr for 24 hours may be used to reduce the incidence of potential side effects.
Side effects requiring immediate medical attention
Along with its needed effects, morphine (the active ingredient contained in Morphine Sulfate ER) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking morphine:
Less common
- Blurred vision.
- bulging soft spot on the head of an infant.
- burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings.
- change in the ability to see colors, especially blue or yellow.
- chest pain or discomfort.
- chills.
- confusion.
- cough.
- decreased urination.
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position.
- fainting.
- fast, pounding, or irregular heartbeat or pulse.
- headache.
- hives, itching, or skin rash.
- increased sweating.
- loss of appetite.
- nausea.
- nervousness.
- pounding in the ears.
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue.
- severe constipation.
- severe vomiting.
- shakiness in the legs, arms, hands, or feet.
- slow heartbeat
- stomach pain.
- sweating.
- vomiting.
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