ADMINISTRATION ROUTES:
IV, PO, NG
ALTERNATIVE NAMES:
RA morph (morphine hydrochloride), LA morph, m-Eslon, Sevredol
ICU INDICATIONS:
- Analgesia
- Sedation
PRESENTATION AND ADMINISTRATION:
IV:
Morphine sulphate: 10 mg/1 mL and 30 mg/1 mL vial. Also available as 50 mg in 50 mL prefilled syringes.
Morphine tartrate: 120 mg in 1.5 mL (used primarily to make up morphine Patient Controlled Analgesia (PCA) at double strength i.e. 120 mg in 60 mL)
For direct injection, dilute 10 mg into a total of 10 mL of compatible IV fluid
For infusion, use prefilled syringes or dilute with compatible IV fluid to a dilution of 1mg/ mL
Compatible with the following IV fluids: 0.9% saline, 5% dextrose, Hartmann's, Glucose and sodium chloride.
Store at room temperature. Protect from light. Store in controlled drug safe.
PO:
Immediate Release Tablets:
- Sevredol 10 mg tablets (blue)
- Sevredol 20 mg tablets (pink)
Sustained Release (SR) Tablets:
- LA Morph 10 mg tablets (buff)
- LA Morph 30 mg tablets (violet)
- LA Morph 60 mg tablets (orange)
- LA Morph 100 mg tablets (grey)
Sustained Release (SR) Capsules:
- m-Eslon SR 10 mg (yellow cap)
- m-Eslon SR 30 mg (pink cap)
- m-Eslon SR 60 mg (orange cap)
- m-Eslon SR 100 mg (white cap)
DOSAGE:
PO:
Short acting (sevredol)
5 - 20 mg every 4 hours
Long acting (SR tablets/capsules) formulations are administered 12 hourly
IV:
Analgesia
1 - 5 mg PRN
Infusion:
0 - 20 mg/hr
Patient Controlled Analgesia (PCA):
1 mg bolus, 5 minute lock-out, maximum of 10 mg/hr
Adjust dose & lock-out time as needed
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | small doses (1 mg) |
| 10-20 | small doses (1 - 2 mg) |
| >20-50 | dose at 75% of normal |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | small doses (1 mg) |
| HD | small doses (1 mg) |
| CVVHDF | small doses (2 mg) |
Note: fentanyl is used in preference to morphine where there is significant renal impairment
DOSAGE IN PAEDIATRICS:
IM:
0.1 - 0.2 mg/kg
IV:
0.05 - 0.1 mg/kg
Give as slow incremental injection over 5 - 15 mins
If intubated & ventilated:
0.1 - 0.2 mg/kg/dose
IV infusion
1 mg/kg in 50 mL 5% dextrose
Infuse at 0 - 4 mL/hr (0-80 mcg/kg/hr)
PCA:
20 mcg/kg boluses (1 mL of 1 mg/kg in 50 mL), 5 minute lock-out
CLINICAL PHARMACOLOGY
Morphine is a pure opiate agonist
CONTRAINDICATIONS:
- Hypersensitivity to morphine
WARNINGS:
Impaired Respiration
Respiratory depression is the main danger of all morphine preparations. Respiratory depression occurs most frequently in the elderly and debilitated patients as well as in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Morphine should be used with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale, and in patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression. In such patients, even usual therapeutic doses of morphine may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea.
Hypotensive Effect
Morphine sulphate controlled-release tablets, like all opioid analgesics, may cause severe hypotension in an individual whose ability to maintain blood pressure has already been compromised by a depleted blood volume, or a concurrent administration of drugs that lower blood pressure.
Anaphylaxis
Although extremely rare, cases of anaphylaxis have been reported. Morphine may cause histamine release causing urticaria and hypotension.
PRECAUTIONS:
General:
Morphine may aggravate pre-existing convulsions in patients with convulsive disorders
Laboratory Tests:
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None noted
IMPORTANT DRUG INTERACTIONS IN ICU:
The concomitant use of other central nervous system depressants including sedatives or hypnotics, general anaesthetics, phenothiazines, tranquilisers, and alcohol may produce additive depressant effects. Respiratory depression, hypotension, and profound sedation or coma may occur.
ADVERSE REACTIONS:
Central Nervous System:
Weakness, headache, agitation, tremor, uncoordinated muscle movements, seizure, alterations of mood (nervousness, apprehension, depression, floating feelings), dreams, muscle rigidity, transient hallucinations and disorientation, visual disturbances, insomnia
Respiratory:
Respiratory depression, apnoea, respiratory arrest
Gastrointestinal:
Dry mouth, biliary tract spasm, laryngospasm, anorexia, diarrhoea, cramps, taste alteration, constipation, ileus, intestinal obstruction, increases in hepatic enzymes
Cardiovascular:
Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension
Genitourinary:
Urine retention or hesitance, reduced libido and/or potency
Dermatologic:
Pruritus, urticaria, other skin rashes, oedema, diaphoresis