Adult Dosing
Severe acute pain, moderate to severe chronic pain
Notes- Consider lower dose, longer interval in elderly patients or patients <50 kgs
- Maintain doses for at least 3 days before reduction, if respiratory activity and other vital signs are adequate on considering reduction of dosages
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[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 reduction recommended but not specified
See Supplemental Patient Information
- Morphine sulfate is an opioid agonist and a schedule II controlled substance having liability for abuse. Strongly consider this when prescribing or dispensing in situations where physician/pharmacist is concerned about an increased risk of misuse abuse or diversion
- Tolerance, psychological and physical dependence has occurred. Avoid abrupt discontinuation
- Use with caution and consider reduction of dosages in patients who are concomitantly receiving other narcotic analgesics, general anesthetics, phenothiazines, other tranquilizers, sedative hypnotics, tricyclic antidepressants, and other CNS depressants (including alcohol). Respiratory depression, hypotension, and profound sedation or coma have occurred
- Marked exaggeration of respiratory depressant effects and elevation of cerebrospinal-fluid pressure in the presence of increased intracranial pressure have occurred in patients undergoing therapy with this drug
- Side effects are produced that obscures the clinical course of patients with head injuries; use therapy in such patients only if it is deemed necessary
- Decreased respiratory drive with simultaneous increase in airway resistance to the point of apnea has occurred in susceptible individuals
- Severe hypotension has occurred in individual's whose ability to maintain blood pressure is compromised by a depleted blood volume or concurrent administration of drugs as the phenothiazines or certain anesthetics
- A significant increase in the ventricular response rate has occurred in susceptible individuals
- Administer reduced dosages in patients, such as the elderly or debilitated and those with severe impairment of hepatic or renal function, hypothyroidism, Addison’s disease, prostatic hypertrophy, or urethral stricture
- Convulsions have occurred in individuals without a history of convulsive disorders on escalation of dosages above recommended levels because of tolerance development
Cautions: Use cautiously in:
- Renal impairment
- Hepatic impairment
- Pulmonary impairment
- COPD
- Cor pulmonale
- Decreased respiratory reserve
- Hypoxia
- Hypercapnia
- Pre-existing respiratory depression
- Circulatory shock
- Coma
- CNS depression
- Head injury
- Intracranial lesion
- ICP increased
- Seizure disorder
- Abuse
- Acute alcoholism
- Delirium tremens
- Toxic psychosis
- Delirium tremens
- Kyphoscoliosis
- Adrenocortical insufficiency
- Adrenal insufficiency (e.g. Addison's Disease)
- Myxedema
- Hypothyroidism
- Toxic psychosis
- Prostatic hypertrophy
- Patients undergoing surgery of the biliary tract
- Urethral stricture
- Acute alcoholism
- Acute abdomen
- Acute pancreatitis or biliary disease
- Inability to swallow
- Patients who are concurrently receiving other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, other tranquilizers, and alcohol
- Geriatrics
- Debilitated patients
Supplemental Patient Information
- Caution patients that the therapy could impair the mental and/or physical abilities needed to perform potentially hazardous activities such as driving a car or operating machinery
- Caution patients about the potential effects of morphine sulfate on concomitant use with other CNS depressants, including other opioids, phenothiazines, sedative/hypnotics and alcohol
Pregnancy Category:C
Breastfeeding: Oral doses of maternal morphine in the immediate postpartum period result in higher milk levels than with epidural morphine; however, these levels are quite low. It is best to limit maternal parenteral morphine dosage and to supplement analgesia with a non narcotic analgesic if mother's milk comes in. If the baby shows signs of increased sleepiness (more than usual), difficulty in breastfeeding, breathing difficulties, or limpness, immediately contact a physician. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 14 February 2011). Manufacturer advises caution.
