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Morphine Sul 0.5mg/ml Inj, 5ml

Manufacturer HOSPIRA Active Ingredient Morphine Injection(MOR feen) Pronunciation MOR-feen
WARNING: For all injections:This is an opioid drug. Opioid drugs can put you at risk for drug use disorder. These can lead to overdose and death. You will be watched closely while taking this drug. Severe breathing problems may happen with this drug. The risk is highest when you first start taking this drug or any time your dose is raised. These breathing problems can be deadly. Call your doctor right away if you have slow, shallow, or trouble breathing.Even one dose of this drug may be deadly if it is taken by someone else or by accident, especially in children. If this drug is taken by someone else or by accident, get medical help right away.Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.Do not take more than what your doctor told you to take. Do not take more often or for longer than you were told. Doing any of these things may raise the chance of severe side effects.Severe side effects have happened when opioid drugs were used with benzodiazepines, alcohol, marijuana, other forms of cannabis, or street drugs. This includes severe drowsiness, breathing problems, and death. Benzodiazepines include drugs like alprazolam, diazepam, and lorazepam. If you have questions, talk with the doctor.Many drugs interact with this drug and can raise the chance of side effects like deadly breathing problems. Talk with your doctor and pharmacist to make sure it is safe to use this drug with all of your drugs.Get medical help right away if you feel very sleepy, very dizzy, or if you pass out. Caregivers or others need to get medical help right away if the patient does not respond, does not answer or react like normal, or will not wake up.If you are pregnant or plan to get pregnant, talk with your doctor right away about the benefits and risks of using this drug during pregnancy. Using this drug for a long time during pregnancy may lead to withdrawal in the newborn baby. Withdrawal in the newborn can be life-threatening if not treated.Injection (if given into the spine):You will be watched closely for breathing problems and other severe effects for at least 24 hours after getting this drug. @ COMMON USES: It is used to manage pain when non- opioid pain drugs do not treat your pain well enough or you cannot take them.
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Drug Class
Opioid analgesic
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Pharmacologic Class
Opioid agonist
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Pregnancy Category
Category C (D if used for prolonged periods or near term)
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FDA Approved
Jan 1941
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DEA Schedule
Schedule II

Overview

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What is this medicine?

Morphine is a strong pain medicine that works in your brain and spinal cord to change how your body feels and responds to pain. It is given by injection, usually in a hospital or clinic setting, for severe pain.
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How to Use This Medicine

Taking Your Medication

To use this medication correctly, follow your doctor's instructions and read all the information provided. It's essential to follow the instructions carefully. This medication is administered via injection into a muscle, vein, or the fatty layer under the skin.

Storing and Disposing of Your Medication

If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage method.

Missing a Dose

If you miss a dose, contact your doctor to receive guidance on what to do next.
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Lifestyle & Tips

  • Avoid alcohol and other sedating medications (e.g., sleeping pills, anxiety medications) unless specifically approved by your doctor, as this can increase the risk of serious side effects like extreme drowsiness and breathing problems.
  • Do not drive or operate heavy machinery until you know how this medication affects you, as it can cause dizziness, drowsiness, and impaired judgment.
  • To prevent constipation, drink plenty of fluids, eat fiber-rich foods, and use a stool softener or laxative as recommended by your healthcare provider.
  • Report any unusual symptoms or side effects to your nurse or doctor immediately.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: Initial: 2-10 mg IV/IM/SC every 3-4 hours as needed for pain. Dosage should be individualized based on patient response and tolerability.

Condition-Specific Dosing:

acutePain_IV: Initial: 2-10 mg IV every 3-4 hours as needed. May be given in smaller increments (e.g., 1-2 mg) every 5-10 minutes until pain relief is achieved, then transition to scheduled or PRN dosing.
postoperativePain_PCA: Loading dose: 2-5 mg IV. Demand dose: 0.5-2 mg. Lockout interval: 5-10 minutes. 4-hour limit: 30-80 mg (highly variable, individualized).
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Pediatric Dosing

Neonatal: Not established for routine use; extreme caution and reduced doses required if used (e.g., 0.01-0.03 mg/kg/dose IV/IM/SC every 4-6 hours, titrate carefully).
Infant: 0.05-0.2 mg/kg/dose IV/IM/SC every 2-4 hours as needed. Max single dose: 15 mg. Titrate carefully.
Child: 0.05-0.2 mg/kg/dose IV/IM/SC every 2-4 hours as needed. Max single dose: 15 mg. Titrate carefully.
Adolescent: Similar to adult dosing, 0.05-0.2 mg/kg/dose IV/IM/SC every 2-4 hours as needed, up to 10 mg/dose initially.
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Dose Adjustments

Renal Impairment:

Mild: Consider dose reduction or extended dosing interval.
Moderate: Reduce dose by 25-50% or extend dosing interval. Monitor closely for sedation and respiratory depression.
Severe: Reduce dose by 50-75% or extend dosing interval significantly. Avoid if possible. Monitor closely for sedation and respiratory depression due to accumulation of active metabolite (morphine-6-glucuronide).
Dialysis: Morphine and its metabolites are dialyzable to some extent. Administer after dialysis. Significant dose reduction required. Monitor closely.

Hepatic Impairment:

Mild: Consider dose reduction or extended dosing interval.
Moderate: Reduce dose by 25-50%. Monitor closely for sedation and respiratory depression.
Severe: Reduce dose by 50-75%. Avoid if possible. Monitor closely for sedation and respiratory depression.
Confidence: Medium

Pharmacology

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Mechanism of Action

Morphine is an opioid agonist that primarily acts on mu-opioid receptors in the central nervous system (CNS), gastrointestinal tract, and other peripheral tissues. Binding to these receptors inhibits the release of neurotransmitters (e.g., substance P, acetylcholine, norepinephrine, dopamine) involved in pain transmission, leading to analgesia. It also produces euphoria, respiratory depression, miosis, and decreased gastrointestinal motility.
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Pharmacokinetics

Absorption:

Bioavailability: 100% (IV/IM/SC); 20-40% (oral, due to extensive first-pass metabolism)
Tmax: IV: 10-20 minutes; IM: 30-60 minutes; SC: 60-90 minutes
FoodEffect: Not applicable for injection; oral formulations may have altered absorption with food.

Distribution:

Vd: 1-4 L/kg
ProteinBinding: Approximately 30-35%
CnssPenetration: Limited, but sufficient to produce CNS effects

Elimination:

HalfLife: Parent drug: 2-4 hours; M6G: 3-5 hours (can be significantly prolonged in renal impairment)
Clearance: Approximately 15-30 mL/min/kg
ExcretionRoute: Primarily renal (90% as metabolites, 7-10% as unchanged drug)
Unchanged: Approximately 7-10%
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Pharmacodynamics

OnsetOfAction: IV: Rapid (within minutes); IM: 10-30 minutes; SC: 15-60 minutes
PeakEffect: IV: 10-20 minutes; IM: 30-60 minutes; SC: 60-90 minutes
DurationOfAction: 3-5 hours (variable, depending on dose and route)
Confidence: High

Safety & Warnings

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BLACK BOX WARNING

RISK OF ADDICTION, ABUSE, AND MISUSE; RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS. Morphine Sulfate Injection exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing Morphine Sulfate Injection, and monitor all patients regularly for the development of these behaviors and conditions. Serious, life-threatening, or fatal respiratory depression may occur. Accidental ingestion of Morphine Sulfate Injection, especially by children, can result in a fatal overdose. Prolonged use of Morphine Sulfate Injection during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.
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Side Effects

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
 Signs of low blood sugar, including:
+ Dizziness
+ Headache
+ Feeling sleepy or weak
+ Shaking
+ Rapid heartbeat
+ Confusion
+ Hunger
+ Sweating
Severe dizziness or fainting
 Chest pain or pressure, or a rapid heartbeat
Confusion
 Breathing difficulties, slow breathing, or shallow breathing
Noisy breathing or sleep apnea (breathing problems during sleep)
 Seizures
Severe constipation or stomach pain, which may indicate a severe bowel problem
 Depression or other mood changes
Swelling in the arms or legs
 Fever, chills, or sore throat
Pain while urinating
 Abnormal sensations, such as burning, numbness, or tingling
Serotonin syndrome, a potentially life-threatening condition, which may occur when taking this medication with certain other drugs. Symptoms include:
+ Agitation
+ Balance problems
+ Confusion
+ Hallucinations
+ Fever
+ Rapid or abnormal heartbeat
+ Flushing
+ Muscle twitching or stiffness
+ Seizures
+ Shivering or shaking
+ Excessive sweating
+ Severe diarrhea, nausea, or vomiting
+ Severe headache
 Adrenal gland problems, which may occur with long-term opioid use. Symptoms include:
+ Extreme fatigue or weakness
+ Fainting
+ Severe dizziness
+ Nausea and vomiting
+ Decreased appetite
Hormonal changes, which may occur with long-term opioid use. Symptoms include:
+ Decreased interest in sex
+ Fertility problems
+ Missed menstrual periods
+ Ejaculation problems

Additional Side Effects:

Most people do not experience severe side effects, but some may occur. If you notice any of the following symptoms, contact your doctor or seek medical attention if they bother you or persist:

 Dizziness, drowsiness, fatigue, or weakness
Dry mouth
 Constipation, diarrhea, stomach pain, nausea, vomiting, or decreased appetite
Headache
 Anxiety
Excessive sweating

Reporting Side Effects:

If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Important Note:

Injection into the spine may cause additional side effects, including:
 Loss of movement
Muscle spasms
 Difficulty controlling body movements
* Urination problems

If you experience any of these symptoms, seek medical attention immediately.
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Seek Immediate Medical Attention If You Experience:

  • Slow or shallow breathing
  • Extreme drowsiness or difficulty waking up
  • Dizziness or lightheadedness when standing up
  • Severe constipation
  • Confusion or hallucinations
  • Severe itching or rash
  • Swelling of the face, lips, tongue, or throat (signs of allergic reaction)
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Before Using This Medicine

Before Taking This Medication: Important Information to Share with Your Doctor

To ensure your safety while taking this medication, it is crucial that you inform your doctor about the following:

Any allergies you have, including allergies to this drug, any of its components, or other substances, such as foods or drugs. Describe the allergic reactions you have experienced.
 Certain health conditions, including:
+ Respiratory problems like asthma, breathing difficulties, or sleep apnea
+ Elevated carbon dioxide levels in the blood
+ Stomach or bowel obstruction or narrowing
Recent use (within the last 14 days) of specific medications for depression or Parkinson's disease, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure
 Current use of any of the following drugs: buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine

Additional Considerations for Injection Administered into the Spine:

Presence of an infection at the injection site
 Bleeding disorders
* Use of blood thinners

This list is not exhaustive, and it is essential to disclose all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues to your doctor and pharmacist. They will assess the safety of taking this medication in conjunction with your other treatments and health conditions. Never initiate, cease, or adjust the dosage of any medication without first consulting your doctor.
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Precautions & Cautions

Important Warnings and Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.

Interactions with Other Medications
Do not take this medication with other strong pain medications or use a pain patch without first consulting your doctor.

Monitoring Your Pain
If your pain worsens, you experience increased sensitivity to pain, or you develop new pain after taking this medication, contact your doctor immediately. Do not exceed the prescribed dose.

Tolerance and Dependence
Long-term or high-dose use of this medication may lead to tolerance, where the medication becomes less effective, and higher doses are required to achieve the same effect. If you experience a decrease in the medication's effectiveness, consult your doctor. Do not take more than the prescribed dose. Additionally, regular use of opioid medications like this one can cause dependence. If you need to reduce the dose or stop taking this medication, consult your doctor to avoid withdrawal or other severe problems. Follow your doctor's instructions carefully and report any increased pain, mood changes, suicidal thoughts, or other adverse effects.

Allergies and Interactions
If you are allergic to sulfites, discuss this with your doctor, as some products contain sulfites. Avoid consuming alcohol or products containing alcohol, as this can lead to unsafe and potentially fatal effects.

Seizure Risk
This medication may increase the risk of seizures, particularly in individuals with a history of seizures. Consult your doctor to determine if you are at a higher risk of seizures while taking this medication.

Special Precautions
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects. If you are breastfeeding, inform your doctor, as this medication passes into breast milk and may harm your baby. Seek medical attention immediately if your baby appears excessively sleepy, limp, or has breathing difficulties.
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Overdose Information

Overdose Symptoms:

  • Pinpoint pupils
  • Extreme drowsiness or unresponsiveness (coma)
  • Slow, shallow, or stopped breathing
  • Bluish discoloration of lips and fingernails (cyanosis)
  • Cold, clammy skin
  • Limp muscles
  • Low blood pressure
  • Slowed heart rate

What to Do:

Seek immediate emergency medical attention. Call 911 or your local emergency number. Naloxone (Narcan) may be administered by emergency personnel to reverse the effects of opioid overdose. Provide information about the drug taken. Call 1-800-222-1222 (Poison Control) for additional guidance.

Drug Interactions

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Major Interactions

  • Benzodiazepines and other CNS depressants (e.g., alcohol, sedatives, hypnotics, anxiolytics, tranquilizers, general anesthetics, phenothiazines, other opioids): Increased risk of profound sedation, respiratory depression, coma, and death.
  • Mixed agonist/antagonist opioids (e.g., buprenorphine, nalbuphine, pentazocine): May precipitate withdrawal symptoms or reduce analgesic effect.
  • Monoamine Oxidase Inhibitors (MAOIs): Concomitant use or within 14 days of MAOI discontinuation can result in severe, unpredictable reactions including serotonin syndrome or opioid overdose symptoms (e.g., respiratory depression, coma).
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Moderate Interactions

  • Anticholinergics (e.g., atropine, scopolamine, tricyclic antidepressants): Increased risk of severe constipation and/or urinary retention.
  • Muscle relaxants: Enhanced neuromuscular blockade.
  • Diuretics: Opioids may reduce the efficacy of diuretics by inducing the release of antidiuretic hormone.
  • Antihypertensives: May cause additive hypotensive effects.
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Minor Interactions

  • Not available

Monitoring

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Baseline Monitoring

Pain level (e.g., NRS, VAS)

Rationale: To establish baseline pain intensity and guide initial dosing.

Timing: Prior to first dose

Respiratory rate and depth

Rationale: To assess baseline respiratory function and identify risk for respiratory depression.

Timing: Prior to first dose

Level of consciousness/sedation (e.g., Pasero Opioid-Induced Sedation Scale)

Rationale: To assess baseline mental status and identify risk for over-sedation.

Timing: Prior to first dose

Blood pressure and heart rate

Rationale: To assess baseline cardiovascular status.

Timing: Prior to first dose

Renal and hepatic function tests (e.g., BUN, creatinine, LFTs)

Rationale: To identify potential impairment that may require dose adjustment.

Timing: Prior to initiation, especially in patients with known or suspected impairment

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Routine Monitoring

Pain level

Frequency: Every 1-4 hours (acute pain), or as needed based on patient response and clinical setting.

Target: Patient-specific goal for pain relief.

Action Threshold: Inadequate pain relief or worsening pain requires reassessment and potential dose adjustment.

Respiratory rate and depth

Frequency: Every 1-4 hours (acute pain), or more frequently if sedation or respiratory depression is noted.

Target: Typically >10-12 breaths/minute, regular rhythm.

Action Threshold: Respiratory rate <10 breaths/minute, shallow breathing, or signs of hypoventilation (e.g., cyanosis, decreased SpO2) require immediate intervention (e.g., naloxone, respiratory support).

Level of consciousness/sedation

Frequency: Every 1-4 hours (acute pain), or more frequently if sedation is noted.

Target: Awake and alert, or easily aroused.

Action Threshold: Excessive sedation (e.g., difficult to arouse, somnolent) requires intervention (e.g., naloxone, holding dose, reducing dose).

Blood pressure and heart rate

Frequency: Every 1-4 hours (acute pain), or as clinically indicated.

Target: Within patient's normal range.

Action Threshold: Significant hypotension or bradycardia requires intervention.

Bowel function

Frequency: Daily

Target: Regular bowel movements.

Action Threshold: Constipation requires prophylactic laxatives and/or bowel regimen.

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Symptom Monitoring

  • Sedation
  • Respiratory depression (slow, shallow breathing)
  • Nausea and vomiting
  • Constipation
  • Pruritus (itching)
  • Dizziness
  • Lightheadedness
  • Confusion
  • Urinary retention
  • Miosis (pinpoint pupils)

Special Patient Groups

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Pregnancy

Use during pregnancy should be avoided unless the potential benefits outweigh the risks. Prolonged use during pregnancy can lead to neonatal opioid withdrawal syndrome (NOWS), which is life-threatening if not recognized and treated. Morphine crosses the placenta.

Trimester-Specific Risks:

First Trimester: Limited data, but potential for congenital malformations with first-trimester opioid exposure is suggested by some studies, though not definitively established for morphine.
Second Trimester: Risk of NOWS increases with prolonged use. Fetal respiratory depression may occur.
Third Trimester: High risk of neonatal opioid withdrawal syndrome (NOWS) if used chronically. Risk of fetal respiratory depression and bradycardia, especially if used near term or during labor.
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Lactation

Morphine is excreted into breast milk. While generally considered compatible with breastfeeding for short-term, single-dose use, caution is advised with repeated or high doses. Monitor the infant for signs of sedation, respiratory depression, and poor feeding.

Infant Risk: Low to moderate risk with careful monitoring. Risk increases with higher maternal doses, prolonged use, and in preterm or neonates. Signs of concern include increased sleepiness, difficulty breathing, poor feeding, and limpness.
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Pediatric Use

Use with extreme caution, especially in neonates and infants, due to increased sensitivity to respiratory depression and variable metabolism. Dosing must be individualized and carefully titrated based on weight, age, and clinical response. Close monitoring for respiratory depression and sedation is essential.

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Geriatric Use

Start with lower doses and titrate slowly due to increased sensitivity to opioid effects (e.g., respiratory depression, sedation, constipation) and potential for decreased renal and hepatic function. Monitor closely for adverse effects.

Clinical Information

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Clinical Pearls

  • Morphine is a potent opioid; always start with the lowest effective dose and titrate slowly, especially in opioid-naive patients, elderly, or those with renal/hepatic impairment.
  • Respiratory depression is the most serious adverse effect; monitor respiratory rate, depth, and sedation level frequently.
  • Tolerance and physical dependence can develop with prolonged use. Do not discontinue abruptly after chronic use to avoid withdrawal symptoms.
  • Opioid-induced constipation is common; prophylactic bowel regimen (e.g., stool softener plus stimulant laxative) should be initiated concurrently with morphine therapy.
  • Naloxone should be readily available for reversal of opioid overdose.
  • Educate patients and caregivers on safe storage to prevent accidental ingestion, especially by children.
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Alternative Therapies

  • Other opioid analgesics (e.g., hydromorphone, fentanyl, oxycodone, hydrocodone, tramadol)
  • Non-opioid analgesics (e.g., NSAIDs, acetaminophen) for less severe pain or as adjuncts
  • Regional anesthesia/nerve blocks
  • Adjuvant analgesics (e.g., gabapentin, pregabalin, tricyclic antidepressants for neuropathic pain)
  • Non-pharmacological pain management (e.g., physical therapy, massage, heat/cold therapy, acupuncture, cognitive behavioral therapy)
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Cost & Coverage

Average Cost: Varies widely by concentration, volume, and supplier. per 5ml vial
Generic Available: Yes
Insurance Coverage: Tier 1 or 2 (generic), Tier 3 (brand) for most insurance plans, often requires prior authorization for chronic use.
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General Drug Facts

If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, do not share your medication with others, and never take someone else's medication. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. If you are unsure about the best disposal method, consult your pharmacist, as there may be drug take-back programs available in your area.

This medication is accompanied by a Medication Guide, which provides important information about its use. Read this guide carefully and review it again each time your prescription is refilled. If you have any questions or concerns about this medication, discuss them with your doctor, pharmacist, or other healthcare provider.

In the event of an overdose, a medication called naloxone can be used as part of the treatment. Consult your doctor or pharmacist about obtaining and using naloxone. If you suspect an overdose has occurred, seek immediate medical attention, even if naloxone has been administered. Be prepared to provide information about the overdose, including the substance taken, the amount, and the time it occurred, to ensure prompt and effective treatment.