Dangerous Drug: Morphine Sulfate(mor’ feen)
Timed-release: AvinzaDNC, KadianDNC, MS ContinDNC, Oramorph SRDNC, ratio-Morphine SR (CAN)DNC
Oral solution: MSIR, Roxanol, Roxanol T
Rectal suppositories: RMS
Injection: Astramorph PF, Duramorph, Morphine HP Injection (CAN), MOS Sulfate (CAN), PMS Morphine (CAN)
Preservative-free concentrate for microinfusion devices for intraspinal use: Infumorph, Morphine LP Injection (CAN), Morphine LP Epidural (CAN)
Liposome injection: DepoDur
PREGNANCY CATEGORY C
CONTROLLED SUBSTANCE C-II
Drug class
Opioid agonist analgesic
Therapeutic Actions
Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).
Indications
Relief of moderate to severe acute and chronic pain
Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage
Analgesic adjunct during anesthesia
Component of most preparations that are oral alcoholic solutions used for chronic severe pain, especially in terminal cancer patients
Intraspinal use with microinfusion devices for the relief of intractable pain
Treatment of pain following major surgery, ER liposome injection for single-dose administration by epidural route at the lumbar level
Unlabeled uses: Relief of pain associated with MI, postherpetic neuralgia, agitation, angina, pulmonary edema
Contraindications and Cautions
Contraindicated with hypersensitivity to opioids; during labor or delivery of a premature infant (may cross immature blood–brain barrier more readily); after biliary tract surgery or surgical anastomosis; with pregnancy, labor (respiratory depression in neonate; may prolong labor).
Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, pre-existing respiratory depression, hypoxia, hypercapnia (may decrease respiratory drive and increase airway resistance); lactation (wait 4–6 hr after administration to nurse the baby); acute abdominal conditions; CV disease, supraventricular tachycardias; myxedema, seizure disorders, acute alcoholism, delirium tremens; cerebral arteriosclerosis; ulcerative colitis; fever; kyphoscoliosis; Addison disease; prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic impairment.
Available Forms
Injection—0.5, 1, 2, 4, 5, 8, 10, 15, 25, 50 mg/mL; tablets—15, 30 mg; CR tabletsDNC—15, 30, 60, 100, 200 mg; ER tabletsDNC—15, 30, 60, 100, 200 mg; soluble tablets—10, 15, 30 mg; oral solution—20 mg/mL; 10, 20, 100 mg/5 mL; concentrated oral solution—20 mg/mL, 100 mg/5 mL; suppositories—5, 10, 20, 30 mg; SR capsulesDNC—20, 30, 50, 60, 100 mg; ER capsulesDNC—30, 45, 60, 75, 90, 120 mg (Avinza); 10, 20, 30, 40, 50, 60, 70, 80, 100, 130, 150, 200 mg (Kadian); liposome injection—10 mg/mL
Dosages
Adults
Oral
One-third to one-sixth as effective as parenteral administration because of first-pass metabolism; 5–30 mg every 4 hr PO. CR, ER, and SR: 30 mg every 8–12 hr PO or as directed by physician; Kadian: 20–100 mg PO daily–24-hr release system; MS Contin: 200 mg PO every 12 hr; Avinza: 30 mg PO daily; if opioid naïve, increase by 30 mg (or lower) increments every 4 days.
IM or subcutaneous
10 mg (range, 5–20 mg) IM or subcutaneously every 4 hr or as directed by physician.
IV
10 mg IV every 4 hr. Usual individual range is 5–15 mg; usual daily dose is 12–120 mg.
Rectal
10–20 mg rectally every 4 hr or as directed by physician.
Epidural
Initial injection of 5 mg in the lumbar region may provide pain relief for up to 24 hr. If adequate pain relief is not achieved within 1 hr, incremental doses of 1–2 mg may be given at intervals sufficient to assess effectiveness, up to 10 mg/24 hr. For continuous infusion, initial dose of 2–4 mg/24 hr is recommended. Further doses of 1–2 mg may be given if pain relief is not achieved initially.
Liposome injection
10–15 mg by lumbar epidural injection using a catheter or needle prior to major surgery or after clamping the umbilical cord during cesarean section.
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