High Alert
Absorption: Variably absorbed (about 30%) following oral administration. More reliably absorbed from rectal, SUBQ, and IM sites. Following epidural administration, systemic absorption and absorption into the intrathecal space via the meninges occurs.
Distribution: Widely distributed to tissues.
Half-Life: Premature neonates: 1020 hr; Neonates: 7.6 hr; Infants 13 mo: 6.2 hr; Children 6 mo2.5 yr: 2.9 hr; Children 36 yr: 12 hr; Children 619 yr with sickle cell disease: 1.3 hr; Adults: 24 hr.
(analgesia)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
PO | unknown | 60 min | 45 hr |
PO-ER | unknown | 34 hr | 824 hr |
IM | 1030 min | 3060 min | 45 hr |
SUBQ | 20 min | 5090 min | 45 hr |
Rect | unknown | 2060 min | 37 hr |
IV | rapid | 20 min | 45 hr |
Epidural | 630 min | 1 hr | up to 24 hr |
IT | rapid (min) | unknown | up to 24 hr |
Contraindicated in:
Use Cautiously in:
CV: hypotension, bradycardia
Derm: flushing, itching, sweating
EENT: blurred vision, diplopia, miosis
Endo: adrenal insufficiency
GI: constipation, nausea, vomiting
Neuro: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams
Resp: RESPIRATORY DEPRESSION (INCLUDING CENTRAL SLEEP APNEA AND SLEEP-RELATED HYPOXEMIA)
Misc: allodynia, opioid-induced hyperalgesia, physical dependence, psychological dependence, tolerance
Drug-drug:
Drug-Natural Products:
Assess level of consciousness, BP, HR, and respiratory rate before and periodically during administration. If respiratory rate <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Subsequent doses may need to be ↓ by 2550%. Initial drowsiness will ↓ with continued use. Monitor for respiratory depression, especially during initiation or following dose ↑; serious, life-threatening, or fatal respiratory depression may occur. May cause sleep-related breathing disorders (central sleep apnea, sleep-related hypoxemia).
Geri: Assess older adults frequently, as they may be more sensitive to the effects of opioid analgesics and may experience side effects and respiratory complications more frequently.Pedi: Assess pediatric patients frequently; children are more sensitive to the effects of opioid analgesics and may experience respiratory complications, excitability, and restlessness more frequently.Lab Test Considerations:
Toxicity and Overdose:
Do not confuse MS Contin with Oxycontin. Do not confuse morphine with hydromorphone. Do not confuse morphine (nonconcentrated oral liquid) with morphine (concentrated oral liquid).
FDA strongly encourages health care professionals to complete a REMS-compliant education program that includes all the elements of the FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain, available at www.fda.gov/OpioidAnalgesicREMSBlueprint. Information on programs can be found at 1-800-503-0784 or www.opioidanalgesicrems.com.
IV Administration:
Administer slowly at 2.515 mg over 5 min. Rapid administration may lead to ↑ respiratory depression, hypotension, and circulatory collapse.
Instruct patient how and when to ask for pain medication. Do not stop taking without discussing with health care professional; may cause withdrawal symptoms if discontinued abruptly after prolonged use. Do not ↑ doses without discussing with health care professional; may lead to overdose. Discuss safe use, risks, and proper storage and disposal of opioid analgesics with patients and caregivers with each Rx. The Patient Counseling Guide is available at www.fda.gov/OpioidAnalgesicREMSPCG.
Explain to patient and family how and when to administer morphine and how to care for infusion equipment properly. Teach parents or caregivers how to accurately measure liquid medication and to use only the measuring device dispensed with the medication.
NDC Code