Morphine

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General

  • Type: Opiods
  • Dosage Forms: 5, 10, 15, 20, 30, 45, 50, 60, 75, 80, 90, 100, 120, 200, 0.5/ml, 1/ml, 2/ml, 4/ml. 5/ml, 8/ml, 10/ml, 15/ml, 25/ml, 50/ml,
  • Common Trade Names: Astramorph, AVINza, Duramorph, Infumorph, Kadian, MS contin

Adult Dosing

  • Acute pain (Moderate to severe):
    • Oral: 10-30mg q4hr PRN
    • IM: 5-15mg q4hr PRN
    • IV: 2.5-5mg q3hr PRN
      • AMI: 4-8mg q5-15min PRN
      • Critically ill: 2-4mg q1-2hr or 4-8mg q3-4hr PRN
    • Continuous infusion IV, SC: 0.8-10mg/hr (up to 80mg/hr)
      • Critically ill: 2-30mg/hr
      • PCA 0.5-2.5mg q5-10min PRN
    • Epidural (Preservative free)
      • Single dose: 30-100mcg/kg
      • Continuous infusion: 0.2-0.4mg/hr
      • Continuous microinfusion: 3.5-10mg over 24hrs, titrate to effect (max ~30mg)
    • Intrathecal (Preservative free)
      • Single dose: 0.1-03.mg
      • Continuous microinfusion: 0.2-10mg over 24 hours (max ~20mg)
    • Rectal: 10-20mg q3-4hr

Pediatric Dosing

  • Children >6months and <50kg
  • Acute pain (Moderate to severe)
    • Oral: 0.15-0.3mg/kg q3-4hr PRN
    • IM, SC: 0.1-0.2mg/kg
    • IV: 0.05-0.3mg/kg q3-4hr PRN (not to exceed 10mg/dose)
    • Continuous infusion: 10-30mcg/kg/hr
    • PCA 0.01-0.03mg/kg/dose and 0-0.03mg/kg/hr

Special Populations

  • Pregnancy Rating: C
  • Lactation: Enters breast milk
  • Renal Dosing
    • CrCl 10-50: 75% of normal dose
    • CrCl <10: 50% of normal dose
    • HD: Child 50%, adult no adjustment
    • PD: Child 50%
    • CRRT: Child and adults 75%
  • Hepatic Dosing: No adjustment generally (cirrhosis can consider dose adjustment)


Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

  • Circulatory depression, shock, cardiac arrest
  • Bradycardia, hypotension
  • CNS depression, sedation
  • Apnea, respiratory arrest/depression
  • Anaphylaxis, laryngospasm

Common

  • Dependence
  • ADH release, hypogonadism
  • Drowsiness, dizziness, confusion, headache
  • Pruritis
  • Xerostomia, constipation, vomiting
  • Urinary retention
  • Pancytopenia
  • Weakness
  • Hypoxia
  • Histamine release, urticaria
  • Afib, tachycardia, edema, chest pain
  • Abdominal pain

Pharmacology

  • Half-life: Immediate release 2-4hrs; Avinza 24hrs; Kadian 11-13hrs
  • Metabolism: Hepatic
  • Excretion: Urine and feces
  • Mechanism of Action:
    • Binds to opioid receptors in CNS
    • Inhibits ascending pain pathways
    • Alters perception and response to pain
    • Produces CNS depression

See Also

References