Morphine Sul 20mg/5ml(4mg/ml) Sol
WARNING: 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.Make sure you have the right drug; there is more than one strength. A lower strength may not ease pain well enough. A higher strength could lead to accidental overdose and death.Certain strengths of this drug may only be used by people who have been taking drugs like this drug and are used to their effects. The use of these strengths by people who have not been taking drugs like this drug may cause very bad and sometimes deadly breathing problems. Talk with the doctor.Be sure that you know how to measure your dose. Dosing errors can lead to accidental overdose and death. If you have any questions, talk with your doctor or pharmacist. @ 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.
Drug Class
Opioid Analgesic
Pharmacologic Class
Opioid Agonist
Pregnancy Category
Not available
FDA Approved
Jan 1970
DEA Schedule
Schedule II
Overview
What is this medicine?
Morphine is a strong pain medicine that belongs to a group of drugs called opioids. It works in your brain and spinal cord to change how your body feels and responds to pain. It is used to treat moderate to severe pain.
How to Use This Medicine
Taking Your Medication Correctly
To use this medication safely and effectively, follow your doctor's instructions and read all the information provided. Take this medication by mouth only, with or without food. If it causes stomach upset, take it with food to help minimize this side effect. Do not inject or snort this medication, as this can lead to severe side effects, including breathing difficulties and overdose, which can be fatal.
When taking the liquid form of this medication, measure your dose carefully using the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device. Avoid using household teaspoons or tablespoons, as these can lead to inaccurate dosing and potentially harmful side effects.
Storing and Disposing of Your Medication
Store this medication at room temperature, protected from light and moisture. Keep it in a dry place, avoiding storage in bathrooms. To ensure safety, store this medication in a secure location where children and pets cannot access it, and where others cannot easily find it. Consider using a locked box or area for storage.
When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. Instead, check with your pharmacist for the best disposal method or look into local drug take-back programs.
Missing a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses.
If you take this medication as needed, follow your doctor's instructions regarding how often to take it. Do not exceed the recommended frequency without consulting your doctor.
To use this medication safely and effectively, follow your doctor's instructions and read all the information provided. Take this medication by mouth only, with or without food. If it causes stomach upset, take it with food to help minimize this side effect. Do not inject or snort this medication, as this can lead to severe side effects, including breathing difficulties and overdose, which can be fatal.
When taking the liquid form of this medication, measure your dose carefully using the measuring device that comes with the medication. If one is not provided, ask your pharmacist for a suitable measuring device. Avoid using household teaspoons or tablespoons, as these can lead to inaccurate dosing and potentially harmful side effects.
Storing and Disposing of Your Medication
Store this medication at room temperature, protected from light and moisture. Keep it in a dry place, avoiding storage in bathrooms. To ensure safety, store this medication in a secure location where children and pets cannot access it, and where others cannot easily find it. Consider using a locked box or area for storage.
When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so by your pharmacist. Instead, check with your pharmacist for the best disposal method or look into local drug take-back programs.
Missing a Dose
If you take this medication regularly and miss a dose, take it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses.
If you take this medication as needed, follow your doctor's instructions regarding how often to take it. Do not exceed the recommended frequency without consulting your doctor.
Lifestyle & Tips
- Do not drink alcohol while taking morphine, as it can increase the risk of serious side effects like extreme drowsiness and breathing problems.
- Avoid driving or operating heavy machinery until you know how morphine affects you, as it can cause dizziness and drowsiness.
- To prevent constipation, drink plenty of fluids, eat fiber-rich foods, and use a stool softener or laxative as recommended by your doctor.
- Store morphine securely, out of reach of children and pets, to prevent accidental ingestion, which can be fatal.
- Do not share your medication with anyone else, as it can be dangerous and is against the law.
Available Forms & Alternatives
Available Strengths:
- Morphine Sulf Rect 20mg Suppository
- Morphine Sul 10mg Rect Suppository
- Morphine Sulf Rect 30mg Suppository
- Morphine Sulf Rect 5mg Suppository
- Morphine Sul 15mg ER Tabs (12h)
- Morphine Sul 30mg ER Tabs (12h)
- Morphine Sul 60mg ER Tabs (12h)
- Morphine Sulf 100mg ER Tabs (12h)
- Morphine Sulf 200mg ER Tabs (12h)
- Morphine Sul 50mg/ml Inj , 20ml
- Morphine Sul 50mg/ml Inj, 50ml
- Morphine Sul 1mg/ml Inj 10ml
- Morphine Sul 30mg Imm Rel Tab
- Morphine Sul 15mg Imm Rel Tab
- Morphine Sul 10mg/5ml(2mg/ml) Sol
- Morphine Sul 20mg/5ml(4mg/ml) Sol
- Morphine Sulf 100mg/5ml(20mg/ml)sol
- Morphine Sul 10mg/ml Inj, 1ml
- Morphine Sul 10mg ER Caps (24h)
- Morphine Sul 30mg ER Caps (24h)
- Morphine Sul 60mg ER Caps (24h)
- Morphine Sul 45mg ER Caps (24h)
- Morphine Sul 75mg ER Caps (24h)
- Morphine Sul 90mg ER Caps (24h)
- Morphine Sulf 120mg ER Caps (24h)
- Morphine Sul 80mg ER Caps (24h)
- Morphine Sul 30mg ER Caps (24h)
- Morphine Sul 20mg ER Caps(24h)
- Morphine Sul 50mg ER Caps(24h)
- Morphine Sulf 100mg ER Caps (24h)
- Morphine Sul 4mg/ml Inj, 1ml
- Morphine Sulf 100mg/5ml(20mg/ml)sol
- Morphine Sulfate 2mg/ml Inj 1ml
- Morphine Sulf Inj 4mg/ml 1ml Syr
- Morphine Sul 2mg/ml Inj 1ml
- Morphine Sul 8mg/ml Inj, 1ml
- Morphine Sul 30mg ER Tabs
- Morphine Sulfate 4mg/ml Inj, 1ml
- Morphine Sulfate 10mg/ml Inj, 1ml
- Morphine Sul 0.5mg/ml Inj, 5ml
- Morphine Sul 8mg/ml Inj, 1ml Vial
Dosing & Administration
Adult Dosing
Standard Dose:
Initial dose for moderate to severe pain: 10-30 mg orally every 4 hours as needed. Dosage should be individualized based on patient response and tolerability.
Dose Range:
4 - 60 mg
Condition-Specific Dosing:
acutePain:
Initial: 10-30 mg every 4 hours as needed. Titrate to effect.
chronicPain:
Individualize dosage and titration. Often started at lower doses and titrated slowly. For opioid-naive patients, consider 5-15 mg every 4 hours initially.
cancerPain:
Individualize dosage. May require higher doses and more frequent administration based on pain severity and previous opioid exposure.
Pediatric Dosing
Neonatal:
Not established for routine use; extreme caution and specialized care required due to high risk of respiratory depression and withdrawal.
Infant:
Not established for routine use; extreme caution and specialized care required. Limited data, often 0.05-0.2 mg/kg/dose every 4 hours, but highly individualized.
Child:
Initial: 0.2-0.5 mg/kg/dose every 4 hours as needed (max 15 mg/dose). Titrate to effect. Max daily dose often 20 mg/kg/day or 120 mg/day, whichever is less.
Adolescent:
Similar to adult dosing, but individualize based on weight and opioid tolerance. Initial: 0.2-0.5 mg/kg/dose every 4 hours as needed (max 15 mg/dose).
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment, but monitor for increased effects.
Moderate:
Reduce initial dose by 25-50% and/or extend dosing interval. Monitor closely for respiratory depression and sedation.
Severe:
Reduce initial dose by 50-75% and/or extend dosing interval significantly (e.g., every 6-8 hours or longer). Avoid if possible. Monitor closely for accumulation of morphine and its active metabolite (morphine-6-glucuronide).
Dialysis:
Morphine and its metabolites are partially dialyzable. Administer after dialysis. Significant dose reduction (e.g., 25% of normal dose) and extended intervals are typically required. Monitor closely.
Hepatic Impairment:
Mild:
No specific adjustment, but monitor for increased effects.
Moderate:
Reduce initial dose by 25-50%. Monitor closely for respiratory depression and sedation.
Severe:
Reduce initial dose by 50-75%. Avoid if possible. Monitor closely for increased and prolonged effects due to impaired metabolism and clearance.
Pharmacology
Mechanism of Action
Morphine is an opioid agonist that primarily acts on mu-opioid receptors in the central nervous system (CNS) and peripheral tissues. Activation of these receptors leads to inhibition of pain transmission, modulation of pain perception, and various other effects including respiratory depression, sedation, euphoria, and gastrointestinal motility reduction.
Pharmacokinetics
Absorption:
Bioavailability:
20-40% (oral, due to significant first-pass metabolism)
Tmax:
Oral solution: 30-60 minutes
FoodEffect:
Food may slightly delay absorption but does not significantly affect the extent of absorption.
Distribution:
Vd:
3-4.7 L/kg
ProteinBinding:
30-35%
CnssPenetration:
Yes, readily crosses the blood-brain barrier.
Elimination:
HalfLife:
2-4 hours (parent drug); M6G half-life is longer, especially in renal impairment.
Clearance:
Not available (highly variable)
ExcretionRoute:
Renal (primarily as glucuronide conjugates)
Unchanged:
Less than 10% (oral)
Pharmacodynamics
OnsetOfAction:
Oral solution: 15-60 minutes
PeakEffect:
Oral solution: 60-90 minutes
DurationOfAction:
Oral solution: 4-5 hours
Safety & Warnings
BLACK BOX WARNING
WARNING: ADDICTION, ABUSE, AND MISUSE; RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS.
ADDICTION, ABUSE, AND MISUSE: Morphine 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, and monitor all patients regularly for the development of these behaviors and conditions.
RESPIRATORY DEPRESSION: Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation of morphine or following a dose increase.
ACCIDENTAL INGESTION: Accidental ingestion of even one dose of morphine, especially by children, can result in a fatal overdose of morphine.
NEONATAL OPIOID WITHDRAWAL SYNDROME: Prolonged use of morphine during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.
CYTOCHROME P450 3A4 INTERACTION: The concomitant use of morphine with all cytochrome P450 3A4 inhibitors may result in increased plasma concentrations of morphine, leading to increased or prolonged opioid effects. These effects could be more pronounced with concomitant use of CYP3A4 and CYP2D6 inhibitors. The concomitant use of morphine with all CYP3A4 inducers may result in decreased plasma concentrations of morphine, leading to decreased efficacy or a withdrawal syndrome in patients who have developed physical dependence to morphine. Avoid the use of CYP3A4 inhibitors or inducers in patients taking morphine. If concomitant use is necessary, monitor patients for respiratory depression and sedation and consider dose adjustment of morphine and/or the CYP3A4 inhibitor or inducer.
CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS: 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. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.
ADDICTION, ABUSE, AND MISUSE: Morphine 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, and monitor all patients regularly for the development of these behaviors and conditions.
RESPIRATORY DEPRESSION: Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation of morphine or following a dose increase.
ACCIDENTAL INGESTION: Accidental ingestion of even one dose of morphine, especially by children, can result in a fatal overdose of morphine.
NEONATAL OPIOID WITHDRAWAL SYNDROME: Prolonged use of morphine during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.
CYTOCHROME P450 3A4 INTERACTION: The concomitant use of morphine with all cytochrome P450 3A4 inhibitors may result in increased plasma concentrations of morphine, leading to increased or prolonged opioid effects. These effects could be more pronounced with concomitant use of CYP3A4 and CYP2D6 inhibitors. The concomitant use of morphine with all CYP3A4 inducers may result in decreased plasma concentrations of morphine, leading to decreased efficacy or a withdrawal syndrome in patients who have developed physical dependence to morphine. Avoid the use of CYP3A4 inhibitors or inducers in patients taking morphine. If concomitant use is necessary, monitor patients for respiratory depression and sedation and consider dose adjustment of morphine and/or the CYP3A4 inhibitor or inducer.
CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS: 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. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.
Side Effects
Important Side Effects to Report to Your Doctor Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, seek medical attention right away:
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
+ Trouble 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
+ Feeling weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
Severe dizziness or fainting
Chest pain or pressure, or a rapid heartbeat
Confusion
Breathing difficulties, including:
+ Slow or shallow breathing
+ Noisy breathing
+ Sleep apnea (breathing problems during sleep)
Seizures
Severe constipation or stomach pain, which may be signs of a severe bowel problem
Depression or other mood changes
Swelling in the arms or legs
Fever, chills, or sore throat
Painful urination
Abnormal sensations, such as burning, numbness, or tingling
Serotonin syndrome, a potentially life-threatening condition that 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 sex drive
+ Fertility problems
+ Irregular menstrual periods
+ Ejaculation problems
Other Possible Side Effects
Most people do not experience significant side effects, but some may occur. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness, drowsiness, fatigue, or weakness
Dry mouth
Constipation, diarrhea, stomach pain, nausea, vomiting, or decreased appetite
Headache
Anxiety
Excessive sweating
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, seek medical attention right away:
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
+ Trouble 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
+ Feeling weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
Severe dizziness or fainting
Chest pain or pressure, or a rapid heartbeat
Confusion
Breathing difficulties, including:
+ Slow or shallow breathing
+ Noisy breathing
+ Sleep apnea (breathing problems during sleep)
Seizures
Severe constipation or stomach pain, which may be signs of a severe bowel problem
Depression or other mood changes
Swelling in the arms or legs
Fever, chills, or sore throat
Painful urination
Abnormal sensations, such as burning, numbness, or tingling
Serotonin syndrome, a potentially life-threatening condition that 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 sex drive
+ Fertility problems
+ Irregular menstrual periods
+ Ejaculation problems
Other Possible Side Effects
Most people do not experience significant side effects, but some may occur. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness, drowsiness, fatigue, or weakness
Dry mouth
Constipation, diarrhea, stomach pain, nausea, vomiting, or decreased appetite
Headache
Anxiety
Excessive sweating
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Slow or shallow breathing
- Extreme drowsiness or difficulty waking up
- Dizziness or lightheadedness when standing up
- Confusion or unusual thoughts
- Severe constipation or abdominal pain
- Signs of an allergic reaction (e.g., rash, itching, swelling of face/tongue/throat, severe dizziness, trouble breathing)
- Pinpoint pupils
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Respiratory problems like asthma, breathing difficulties, or sleep apnea
+ Elevated carbon dioxide levels in the blood
+ Stomach or bowel blockage or narrowing
If you have taken specific medications for depression or Parkinson's disease within the last 14 days, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure
If you are currently taking any of the following medications: buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine
Please note that this is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist to ensure safe use. Do not initiate, discontinue, or modify the dosage of any medication without consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Respiratory problems like asthma, breathing difficulties, or sleep apnea
+ Elevated carbon dioxide levels in the blood
+ Stomach or bowel blockage or narrowing
If you have taken specific medications for depression or Parkinson's disease within the last 14 days, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure
If you are currently taking any of the following medications: buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine
Please note that this is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist to ensure safe use. Do not initiate, discontinue, or modify the dosage of any medication without consulting your doctor.
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 activities that require you to be alert. 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 become more sensitive to pain, or experience 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 can lead to tolerance, where the medication may not work as well, and you may require higher doses 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 lower your dose or stop taking this medication, consult your doctor first, as sudden changes can increase the risk of withdrawal or other severe problems. Follow your doctor's instructions carefully, and report any increased pain, mood changes, suicidal thoughts, or other adverse effects.
Concomitant Use with Alcohol
Do not consume alcohol or use products containing alcohol while taking this medication, 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. Discuss your risk with your doctor.
Special Precautions for Older Adults
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Breastfeeding
If you are breastfeeding, inform your doctor, as this medication can pass into breast milk and harm your baby. Seek medical attention immediately if your baby appears excessively sleepy, limp, or has breathing difficulties.
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 activities that require you to be alert. 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 become more sensitive to pain, or experience 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 can lead to tolerance, where the medication may not work as well, and you may require higher doses 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 lower your dose or stop taking this medication, consult your doctor first, as sudden changes can increase the risk of withdrawal or other severe problems. Follow your doctor's instructions carefully, and report any increased pain, mood changes, suicidal thoughts, or other adverse effects.
Concomitant Use with Alcohol
Do not consume alcohol or use products containing alcohol while taking this medication, 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. Discuss your risk with your doctor.
Special Precautions for Older Adults
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Breastfeeding
If you are breastfeeding, inform your doctor, as this medication can pass into breast milk and harm your baby. Seek medical attention immediately if your baby appears excessively sleepy, limp, or has breathing difficulties.
Overdose Information
Overdose Symptoms:
- Slowed or stopped breathing (respiratory depression)
- Extreme drowsiness or unresponsiveness
- Pinpoint pupils
- Cold, clammy skin
- Limp muscles
- Bluish discoloration of lips or fingernails
- Loss of consciousness
What to Do:
If you suspect an overdose, call 911 immediately. If naloxone (Narcan) is available, administer it as directed and continue to monitor the person until emergency medical help arrives. Stay with the person and try to keep them awake and breathing. Call 1-800-222-1222 for Poison Control if you need advice.
Drug Interactions
Contraindicated Interactions
- Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of MAOI discontinuation (risk of serotonin syndrome or severe respiratory depression).
Major Interactions
- Benzodiazepines and other CNS depressants (e.g., other opioids, sedatives, hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, alcohol): Increased risk of profound sedation, respiratory depression, coma, and death.
- Serotonergic drugs (e.g., SSRIs, SNRIs, TCAs, triptans, mirtazapine, tramadol, fentanyl): Risk of serotonin syndrome.
- Mixed agonist/antagonist and partial agonist opioids (e.g., butorphanol, nalbuphine, pentazocine, buprenorphine): May precipitate withdrawal symptoms or reduce analgesic effect.
- Anticholinergics (e.g., atropine, scopolamine, tricyclic antidepressants): Increased risk of urinary retention and/or severe constipation, paralytic ileus.
- Diuretics: Opioids may reduce the efficacy of diuretics by causing the release of antidiuretic hormone.
Moderate Interactions
- CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole, ritonavir): May increase morphine plasma concentrations, leading to increased opioid effects.
- CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin): May decrease morphine plasma concentrations, leading to reduced efficacy or withdrawal symptoms.
- P-glycoprotein (P-gp) inhibitors (e.g., quinidine, verapamil): May increase morphine exposure.
- Antihypertensives: May cause additive hypotensive effects.
- Cimetidine: May increase morphine levels.
Minor Interactions
- Metoclopramide: May antagonize the gastrointestinal effects of morphine.
Monitoring
Baseline Monitoring
Pain assessment (intensity, character, location)
Rationale: To establish baseline pain level and guide initial dosing.
Timing: Prior to initiation of therapy
Respiratory rate and depth
Rationale: To assess baseline respiratory function and identify risk for respiratory depression.
Timing: Prior to initiation of therapy
Level of consciousness/sedation
Rationale: To assess baseline mental status and identify risk for excessive sedation.
Timing: Prior to initiation of therapy
Bowel function
Rationale: To assess baseline and anticipate opioid-induced constipation.
Timing: Prior to initiation of therapy
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 suspected impairment
Routine Monitoring
Pain level
Frequency: Regularly, as clinically indicated (e.g., before and 1 hour after dose, then every 2-4 hours during titration, or daily for stable chronic pain)
Target: Patient-specific pain goal (e.g., 0-3 on 0-10 scale)
Action Threshold: Pain score above goal, requiring dose adjustment or rescue medication
Respiratory rate and depth
Frequency: Frequently during initiation/titration (e.g., every 15-30 minutes for first hour, then every 1-2 hours), then periodically (e.g., every 4-8 hours) for stable patients.
Target: Adults: 12-20 breaths/minute, regular rhythm
Action Threshold: Respiratory rate < 10-12 breaths/minute, shallow breathing, or signs of hypoventilation (e.g., cyanosis, somnolence). Administer naloxone if severe.
Level of consciousness/sedation (e.g., Pasero Opioid-Induced Sedation Scale)
Frequency: Concurrently with respiratory rate monitoring.
Target: Alert or mildly drowsy, easily aroused.
Action Threshold: Difficult to arouse, somnolent, or unarousable. Hold dose, consider naloxone.
Bowel function
Frequency: Daily or every other day
Target: Regular bowel movements (e.g., every 1-2 days)
Action Threshold: No bowel movement for 2-3 days, or signs of constipation (e.g., straining, hard stools). Initiate or escalate bowel regimen.
Signs of opioid-induced hyperalgesia or tolerance
Frequency: Periodically, especially with dose escalation or long-term use.
Target: Not applicable
Action Threshold: Increased pain despite dose escalation, or pain in areas not previously affected. Consider opioid rotation or adjunctive therapies.
Symptom Monitoring
- Sedation/drowsiness
- Dizziness
- Nausea/vomiting
- Constipation
- Pruritus
- Urinary retention
- Confusion
- Respiratory depression (slow, shallow breathing)
- Pinpoint pupils
- Signs of opioid withdrawal (e.g., restlessness, yawning, lacrimation, rhinorrhea, piloerection, sweating, muscle aches, abdominal cramps, diarrhea)
Special Patient Groups
Pregnancy
Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS), which can be life-threatening if not recognized and treated. Use only if the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
First Trimester:
Limited data on congenital malformations. Some studies suggest a possible association with neural tube defects and cardiac defects, but evidence is not conclusive.
Second Trimester:
Risk of NOWS increases with prolonged exposure.
Third Trimester:
High risk of NOWS with prolonged exposure. Risk of respiratory depression in the neonate if administered close to delivery.
Lactation
Morphine is excreted into breast milk. Monitor infants for signs of sedation, respiratory depression, and poor feeding. Use with caution, or consider alternative analgesics, especially in preterm or neonates.
Infant Risk:
Risk of sedation, respiratory depression, and withdrawal symptoms in breastfed infants. The American Academy of Pediatrics considers morphine to be a drug for which the effect on the nursing infant is unknown but may be of concern.
Pediatric Use
Use with extreme caution, especially in neonates and infants, due to increased sensitivity to respiratory depression and variable pharmacokinetics. Dosing must be individualized and closely monitored. Not recommended for routine use in very young children.
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
Clinical Pearls
- Morphine oral solution (Roxanol) is often used for rapid titration of pain, especially in hospice or palliative care, due to its quick onset and shorter duration compared to extended-release formulations.
- Always have naloxone readily available when prescribing opioids, especially for patients at higher risk of overdose.
- Educate patients and caregivers on the signs of respiratory depression and how to administer naloxone.
- Prophylactic treatment for opioid-induced constipation (OIC) should be initiated concurrently with morphine therapy, as OIC is a common and persistent side effect.
- Be aware of the potential for opioid-induced hyperalgesia, where increasing doses of opioids can paradoxically increase pain sensitivity.
- The 4 mg/mL concentration (20 mg/5 mL) is a concentrated solution; ensure clear communication and accurate measurement to avoid dosing errors.
Alternative Therapies
- Other opioid analgesics (e.g., oxycodone, hydromorphone, fentanyl, hydrocodone)
- Non-opioid analgesics (e.g., NSAIDs, acetaminophen)
- Adjuvant analgesics (e.g., gabapentin, pregabalin, tricyclic antidepressants, SNRIs for neuropathic pain)
- Regional anesthesia/nerve blocks
- Non-pharmacological therapies (e.g., physical therapy, acupuncture, cognitive behavioral therapy)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 120 mL bottle (4mg/mL)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (generic), Tier 3 or 4 (brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, do not share your medication with others or take someone else's medication.
This medication is accompanied by a Medication Guide, which is a patient fact sheet that provides crucial information. It is vital to read this guide carefully and review it again each time your prescription is refilled. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider.
In the event of an overdose, a medication called naloxone can be administered to help treat the condition. Discuss obtaining and using naloxone with your doctor or pharmacist. If you suspect an overdose has occurred, seek immediate medical attention, even if naloxone has been administered. Be prepared to provide detailed information about the overdose, including the substance taken, the amount, and the time it occurred.
This medication is accompanied by a Medication Guide, which is a patient fact sheet that provides crucial information. It is vital to read this guide carefully and review it again each time your prescription is refilled. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider.
In the event of an overdose, a medication called naloxone can be administered to help treat the condition. Discuss obtaining and using naloxone with your doctor or pharmacist. If you suspect an overdose has occurred, seek immediate medical attention, even if naloxone has been administered. Be prepared to provide detailed information about the overdose, including the substance taken, the amount, and the time it occurred.