Morphine

C₁₇H₁₉NO₃ 285.37 Morphine

a narcotic analgesic. Addictive.

sulfate medication

Morphine

Morphine is naturally occurring substance in the opium poppy, Papaver Somniferous. It is a potent narcotic analgesic, and its primary clinical use is in the management of moderately severe and severe pain. After heroin, morphine has the greatest dependence liability of the narcotic analgesics in common use.

Morphine is administered by several routes (injected, smoked, sniffed, or swallowed); but when injected particularly intravenously, morphine can produce intense euphoria and a general state of well-being and relaxation. Regular use can result in the rapid development of tolerance to these effects. Profound physical and psychological dependence can also rapidly develop, and withdrawal sickness upon abrupt cessation of heroin use; many of the symptoms resemble those produced by a case of moderately severe flu.

Morphine is infrequently encountered in the North American street drug culture. However, mainly because of its availability in hospitals, there have been several documented cases of morphine dependence among health professionals.

Drug Source

Morphine is isolated from crude opium, which is a resinous prep of the opium poppy, Papaver somniferum.

Trade Name

Roxinal, MS Contain, Morphine Sulfate

Street Names

"M", morph, Miss Emma

Drug Combinations

Use of morphine plus cocaine, as well as of morphine plus methamphetamine, has been reported. However, such combinations are not frequently encountered.

Medical Uses

* symptomatic relief of moderately severe to severe pain;

* relief of certain types of difficult or labored breathing;

* suppression of severe cough (rarely);

* suppression of severe diarrhea (e.g., that produced by cholera).

Physical Appearance

Morphine is legally available only in the form of its water-soluble salts. Most common are morphine sulfate and morphine hydrochloride. Both are fine white crystalline powders, bitter to the taste. Both are soluble in water and slightly soluble in alcohol.

Dosage

Medical

For moderate to severe pain the optimal intramuscular dosage is considered to be 10 mg per 70 kg body weight every four hours. The typical dose range is from 5 to 20 mg every four hours, depending on the severity of the pain. The oral dose range is between 8 and 20 mg; but with oral administration morphine has substantially less analgesic potency (approximately one-tenth of the effect produced by subcutaneous injection) because it is rapidly destroyed as it passes through the liver immediately after absorption. The intravenous route is employed primarily for severe post-operative pain or in an emergency; in this case the dose range is between 4 and 10 mg, and the analgesic effect ensues almost immediately.

Nonmedical

Irregular or intermittent users (who are not substituting the drug for another narcotic analgesic) may start and continue to use doses within the therapeutic range (e.i., up to 20 mg). However, regular users who employ morphine for its subjectively pleasurable effects frequently increase the dose as tolerance develops. To take several hundred milligrams per day is common, and there are reliable reports of up to four or five grams (4000 - 5000 mg) per day.

Routes Of Administration

Morphine may be taken orally in tablet form, and can also injected subcutaneously, intramuscularly, or intravenously; the last is the route preferred by those who are dependent on morphine.

Short Term Use

Low Doses (single doses of 5 - 10 mg administered by S.C or IM injection in non-tolerant users)

CNS, behavioral, subjective :

suppression the sensation of and emotional response to pain; euphoria; drowsiness, lethargy, relaxation; difficulty in concentrating; decreased physical activity in some users and increased physical activity in others; mild anxiety or fear; pupillary constriction, blurred vision, impaired night vision, suppression of cough reflex.

Respiratory:

slightly reduced respiratory rate.

Gastrointestinal:

nausea and vomiting; constipation; loss of appetite; decreased gastric motility.

Other:

slight drop in body temperature; sweating; reduced libido; prickly or tingling sensation on the skin (particularly after intravenous injection).

Duration

4 - 5 hours

Dependency Potential

high, continued use results in both psychological and physical dependency

Morphine hydrochloride
Morphine hydrochloride (Morphitec)
Morphine
(MOR-feen)
Pregnancy Category: C Morphitec-1, -5, -10, -20 M.O.S. M.O.S.-S.R. (Rx)
Morphine sulfate
Morphine sulfate (Astramorph PF)
Morphine
(MOR-feen SUL-fayt)
Pregnancy Category: C
Classification: Narcotic analgesic, morphine type Ý

Action/Kinetics: Morphine is the prototype for opiate analgesics. Onset: approximately 15-60 min, based on epidural or intrathecal use. Peak effect: 30-60 min. Duration: 3-7 hr. t1/2: 1.5-2 hr. Oral morphine is only one-third to one-sixth as effective as parenteral products.

Uses: Intrathecally, epidurally, PO (including sustained-release products), or by continuous IV infusion for acute or chronic pain. In low doses, morphine is more effective against dull, continuous pain than against intermittent, sharp pain. Large doses, however, will dull almost any kind of pain. Preoperative medication. To facilitate induction of anesthesia and reduce dose of anesthetic. Investigational: Acute LV failure (for dyspneic seizures) and pulmonary edema. Morphine should not be used with papaverine for analgesia in biliary spasms but may be used with papaverine in acute vascular occlusions.

Additional Contraindications: Epidural or intrathecal morphine: If infection is present at injection site, anticoagulant therapy, bleeding diathesis, if client has received parenteral corticosteroids within the past 2 weeks. Morphine injection: Heart failure secondary to chronic lung disease, cardiac arrhythmias, brain tumor, acute alcoholism, delirium tremens, convulsive states. Immediate release oral solution of morphine: Respiratory insufficiency, severe CNS depression, heart failure secondary to chronic lung disease, cardiac arrhythmias, increased intracranial or CSF pressure, head injuries, brain tumor, acute alcoholism, delirium tremens, after biliary tract surgery, suspected surgical abdomen, convulsive disorders, surgical anastomosis, with MAO inhibitors or within 14 days of these drugs.

Special Concerns: May increase the length of labor. Clients with known seizure disorders may be at greater risk for morphine-induced seizure activity. Respiratory depression may be delayed up to 24 hr after epidural or intrathecal use.

Additional Drug Interactions: Amitriptyline / CNS and respiratory depression Cimetidine / CNS and respiratory depression Clomipramine / CNS and respiratory depression Nortriptyline / CNS and respiratory depression Warfarin / Warfarin anticoagulant effect

How Supplied: Morphine hydrochloride: Syrup: 1 mg/mL, 5 mg/mL, 10 mg/mL, 20 mg/mL; Concentrate: 20 mg/mL, 50 mg/mL; Suppository: 10 mg, 20 mg, 30 mg; Tablets: 10 mg, 20 mg, 40 mg, 60 mg; Slow-release tablets: 30 mg, 60 mg. Morphine sulfate: Capsule: 15 mg, 30 mg; Capsule, Extended Release: 20 mg, 50 mg, 100 mg; Oral Solution: 10 mg/2.5 mL, 10 mg/5 mL, 20 mg/5 mL, 20 mg/mL, 30 mg/1.5 mL, 100 mg/5 mL; Injection: 0.5 mg/mL, 1 mg/mL, 2 mg/mL, 4 mg/mL, 5 mg/mL, 8 mg/mL, 10 mg/mL, 15 mg/mL, 25 mg/mL, 50 mg/mL; Suppository: 5 mg, 10 mg, 20 mg, 30 mg; Tablet: 15 mg, 30 mg; Tablet, Controlled Release: 15 mg, 30 mg, 60 mg, 100 mg, 200 mg; Tablets, Soluble: 10 mg, 15 mg, 30 mg

Dosage
ïCapsules, Tablets, Oral Solution, Soluble Tablets, Syrup Analgesia.
10-20 mg (solution) or 15-30 mg (tablets) q 4 hr.
ïSustained-Release Tablets Analgesia.
Titrate first to analgesia using an immediate release product and then transfer to a long-acting product. To convert from immediate release PO morphine to controlled release PO morphine, give the total daily PO morphine dose q 24 hr if using Kadian; or, 1/2 the total daily PO morphine dose q 12 hr if using Oramorph SR, Kadian, or MS Contin; or, 1/3 the total daily PO morphine dose q 8 hr if using MS Contin. If Kadian is selected as the initial product, start with either 20 mg q 12 hr or 40 mg once daily. The MS Contin 200 mg tablet is only for narcotic tolerant clients requiring daily morphine equivalent doses of 400 or more mg.
ïIM, SC Analgesia.
Adults: 10-20 mg/70 kg q 4 hr as needed; pediatric: 100-200 mcg/kg q 4 hr, up to a maximum of 15 mg/dose.
MI.
8-15 mg. For very severe pain, give additional smaller amounts q 3-4 hr.
ïIV Infusion Analgesia.
Adults: 2.5-15 mg/70 kg in 4-5 mL of water for injection (should be administered slowly over 4-5 min).
ïIV Infusion, Continuous Analgesia.
Adults: 0.1-1 mg/mL in D5W by a controlled-infusion pump.
ïIV Open-heart surgery.
0.5 - 3 mg/kg as the sole anesthetic or with a suitable anesthetic. Give oxygen and adequate ventilation.
ïRectal Suppositories
Adults: 10-20 mg q 4 hr or as directed by provider.
ïIntrathecal
Adults: 0.2-1 mg as a single daily injection.
ïEpidural
Initial: 5 mg/day in the lumbar region; if analgesia is not manifested in 1 hr, increasing doses of 1-2 mg can be given, not to exceed 10 mg/day. For continuous infusion, 2-4 mg/day with additional doses of 1-2 mg if analgesia is not satisfactory.