Adult Dosing
Severe acute pain, moderate to severe chronic pain
- In patients with severe, chronic pain, dosage should be adjusted according to the severity of the pain and the response and tolerance of the patient
- 5-20mg SC/IM q4 hrs prn
- 4-10mg over 4-5min IV
Relief of pain of Myocardial Infarction
- initial: 2-4mg, give 2-8mg q5-15min prn
Testicular Torsion [Non-FDA Approved]
- 2.5-10 mg IM/IV q2-4 hrs PRN
Pulmonary Edema (Non-FDA Approved)
- 1-5 mg IV q5 minutes. Monitor for respiratory depression and/or hypotension
- Note: Best current evidence indicates use of morphine for decompensated heart failure substantially worsens clinical outcomes and generally should not be used (except in the setting of palliative care)
Acute Coronary Syndromes [Non-FDA Approved]
Pediatric Dosing
Severe acute pain, moderate to severe chronic pain
- Child 6 months-12 yrs: 0.1-0.2 mg/kg SC/IM/IV q2-4 hrs (Max: 15 mg/dose)
Testicular Torsion [Non-FDA Approved]
- 0.1-0.2 mg/kg/dose q2-4 hr PRN; max: 10 mg/dose
[Outline]
Renal Dose Adjustment (Based on CrCl)
- 10-50 mL/min: Reduce dose by 25%
- <10 mL/min: Reduce dose by 50%
Hepatic Dose Adjustment
- Severe hepatic impairment: Dose adjustments not defined, dose reduction recommended
- Patients must be observed in a fully equipped and staffed environment for at least 24 hours after the initial dose, because of the risk of severe adverse effects when the epidural or intrathecal route of administration is employed [US Black Box Warning]
- Life-threatening or intolerable side effects should be treated with naloxone injection and resuscitative equipment [US Black Box Warning]
- Morphine can produce drug dependence and, therefore, has the potential for being abused
- Therapy should be used only by those familiar with managing respiratory depression
- Closely monitor for excessive sedation, respiratory depression, or other adverse effects of opioid medications in patients receiving self-administration of opioids by PCA
- Use with extreme caution in patients with increased intracranial pressure or with head injury
- There is risk of acute respiratory failure following morphine administration. Therefore avoid use in cases of chronic asthma, upper airway obstruction, or in any other chronic pulmonary disorder
- Use with caution in patients with hepatic or renal disease because the elimination half-life of morphine may be prolonged in such patients
- Circulating morphine may induce smooth muscle hypertonicity resulting in biliary colic, therefore caution should be exercised in patients with disorders of the biliary tract
- When using concomitantly with other CNS depressants use minimum effective dose of CNS depressants
- Therapy can cause manifestation of unusual accelaration of neuraxial morphine requirement
Cautions: Use cautiously in
Pregnancy Category:C
Breastfeeding: Probably Safe. Once the mother's milk comes in, it is best to limit maternal parenteral morphine dosage and to supplement analgesia with a non narcotic analgesic if necessary. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 22 February 2011). Manufacturer suggests that morphine causes sedation of a nursing infant. Therefore use should be individualized based on the clinical situation.
US Trade Name(s)
- Astramorph PF
- Depodur (Discontinued)
- Duramorph
- Infumorph
US Availability
morphine (generic)
- SOLN for INJ: 0.5 mg/mL
- SOLN for INJ: 1 mg/mL
- SOLN for INJ: 2 mg/mL
- SOLN for INJ: 4 mg/mL
- SOLN for INJ: 5 mg/mL
- SOLN for INJ: 8 mg/mL
- SOLN for INJ: 10 mg/mL
- SOLN for INJ: 15 mg/mL
- SOLN for INJ: 25 mg/mL
- SOLN for INJ: 50 mg/mL
Astramorph PF, Duramorph
- INJ: 0.5 mg/mL
- INJ: 1 mg/mL
Depodur
Infumorph
- INJ: 10 mg/mL
- INJ: 25 mg/mL
Canadian Trade Name(s)
Canadian Availability
morphine (generic)
- INJ: 0.5 mg/mL
- INJ: 1 mg/mL
- INJ: 2 mg/mL
- INJ: 10 mg/mL
- INJ: 15 mg/mL
- INJ: 25 mg/mL
- INJ: 50 mg/mL
UK Trade Name(s)
UK Availability
morphine (generic)
- INJ: 10 mg/mL
- INJ: 15 mg/mL
- INJ: 30 mg/mL
Australian Trade Name(s)
Australian Availability
morphine sulfate (generic)
- INJ: 5 mg/mL
- INJ: 10 mg/mL
- INJ: 15 mg/mL
- INJ: 30 mg/mL
morphine tartarate (generic)
- INJ: 120 mg/1.5 mL
- INJ: 400 mg/5 mL
Depodur
[Outline]
