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Morphine Sul 2mg/ml Inj 1ml

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
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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 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 given by injection, often in a hospital setting, to treat moderate to 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 dosage 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 for guidance on proper storage.

Missing a Dose

If you miss a dose, contact your doctor to determine the best course of action.
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Lifestyle & Tips

  • Avoid alcohol and other sedating medications unless approved by your doctor.
  • Do not drive or operate heavy machinery until you know how this medication affects you, as it can cause drowsiness and dizziness.
  • Report any difficulty breathing, excessive sleepiness, or severe constipation to your healthcare provider immediately.
  • If you are receiving this medication at home, ensure safe storage to prevent accidental ingestion by children or pets, and proper disposal of unused medication.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: Acute Pain (IV): 2-10 mg every 3-4 hours as needed. Chronic Pain (IV): Individualized titration.
Dose Range: 2 - 10 mg

Condition-Specific Dosing:

acutePainIV: 2-10 mg IV/IM/SC every 3-4 hours as needed. Titrate to effect.
patientControlledAnalgesiaPCA: Loading dose: 2-5 mg IV. Demand dose: 0.5-2 mg. Lockout interval: 5-10 minutes. Basal rate: 0-2 mg/hr (optional).
epidural: 2-5 mg initially, followed by 1-2 mg/hr infusion or 1-2 mg bolus every 6-8 hours.
intrathecal: 0.1-0.3 mg single dose.
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Pediatric Dosing

Neonatal: Not established for routine use; extreme caution if used. 0.05-0.1 mg/kg/dose IV/IM/SC every 4-6 hours, max 0.1 mg/kg/dose. Monitor closely for respiratory depression.
Infant: 0.05-0.2 mg/kg/dose IV/IM/SC every 2-4 hours as needed. Max 15 mg/dose. Titrate to effect.
Child: 0.05-0.2 mg/kg/dose IV/IM/SC every 2-4 hours as needed. Max 15 mg/dose. Titrate to effect.
Adolescent: 0.05-0.2 mg/kg/dose IV/IM/SC every 2-4 hours as needed. Max 15 mg/dose. Titrate to effect (or adult dosing if appropriate weight).
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Dose Adjustments

Renal Impairment:

Mild: No specific adjustment, but monitor for increased effects.
Moderate: Reduce dose by 25-50% or extend dosing interval. Monitor closely.
Severe: Reduce dose by 50-75% or extend dosing interval significantly. Avoid if possible due to accumulation of active metabolites (morphine-3-glucuronide, morphine-6-glucuronide).
Dialysis: Morphine and its metabolites are partially dialyzable. Administer after dialysis. Significant dose reduction required.

Hepatic Impairment:

Mild: No specific adjustment, but monitor for increased effects.
Moderate: Reduce dose by 25-50%. Monitor closely.
Severe: Reduce dose by 50-75%. Monitor closely. Avoid if possible due to impaired metabolism.

Pharmacology

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Mechanism of Action

Morphine is a full opioid agonist that acts primarily at the mu-opioid receptors in the central nervous system (CNS) and other tissues. Its analgesic effects are mediated by binding to these receptors, leading to inhibition of ascending pain pathways, altering the perception of and response to pain. It also produces CNS depression, respiratory depression, euphoria, and physical dependence.
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Pharmacokinetics

Absorption:

Bioavailability: 100% (IV/IM/SC)
Tmax: IV: 10-20 minutes; IM: 30-60 minutes; SC: 60-90 minutes
FoodEffect: Not applicable for injectable forms.

Distribution:

Vd: 3-4.7 L/kg
ProteinBinding: 20-35%
CnssPenetration: Yes

Elimination:

HalfLife: 2-4 hours (parent drug); M6G: 3-15 hours (longer in renal impairment)
Clearance: Not readily available as a single rate, highly variable.
ExcretionRoute: Renal (primarily as glucuronide conjugates)
Unchanged: <10% (parent drug)
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Pharmacodynamics

OnsetOfAction: IV: 5-10 minutes; IM: 10-30 minutes; SC: 15-60 minutes
PeakEffect: IV: 20 minutes; IM: 30-60 minutes; SC: 60-90 minutes
DurationOfAction: IV/IM/SC: 3-5 hours

Safety & Warnings

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BLACK BOX WARNING

RISK OF ADDICTION, ABUSE, AND MISUSE; RESPIRATORY DEPRESSION; NEONATAL OPIOID WITHDRAWAL SYNDROME; and RISKS FROM 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 or following a dose increase.

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.

Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants: Concomitant use of opioids with benzodiazepines or other 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.
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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 experience any of the following symptoms, contact your doctor or seek medical attention immediately:

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 passing out
 Chest pain or pressure, or a fast heartbeat
Feeling confused
 Trouble breathing, slow breathing, or shallow breathing
Noisy breathing or breathing problems during sleep (sleep apnea)
 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
Pain when passing urine
 A burning, numbness, or tingling feeling that is not normal

Serotonin Syndrome: A Rare but Serious Condition

Taking this medication with certain other drugs can increase the risk of serotonin syndrome, a potentially life-threatening condition. Seek medical help immediately if you experience:

Agitation
 Change in balance
Confusion
 Hallucinations
Fever
 Fast or abnormal heartbeat
Flushing
 Muscle twitching or stiffness
Seizures
 Shivering or shaking
Sweating a lot
 Severe diarrhea, upset stomach, or throwing up
Severe headache

Adrenal Gland Problems: A Rare but Serious Condition

Taking an opioid medication like this one can increase the risk of adrenal gland problems. Seek medical help immediately if you experience:

 Feeling very tired or weak
Passing out
 Severe dizziness
Very upset stomach
 Throwing up
Decreased appetite

Hormonal Changes: A Potential Side Effect

Long-term use of an opioid medication like this one can lead to lower sex hormone levels. Contact your doctor if you experience:

 Lowered interest in sex
Fertility problems
 No menstrual period
Ejaculation problems

Injection-Related Side Effects (if given into the spine)

If you receive this medication via injection into the spine, seek medical help immediately if you experience:

 Inability to move
Muscle spasm
 Trouble controlling body movements
Trouble passing urine

Other Side Effects

Most people do not experience significant side effects, but some may occur. Contact your doctor or seek medical attention if you experience any of the following side effects or if they bother you or do not go away:

 Feeling dizzy, sleepy, tired, or weak
Dry mouth
 Constipation, diarrhea, stomach pain, upset stomach, throwing up, or decreased appetite
Headache
 Anxiety
* Sweating a lot

Reporting Side Effects

If you have questions about side effects or want to report a side effect, contact your doctor or call the FDA at 1-800-332-1088. You can also report side effects online at https://www.fda.gov/medwatch.
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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 disorientation
  • Pinpoint pupils
  • Blue lips or fingernails
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Before Using This Medicine

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

To ensure safe treatment, inform your doctor about the following:

Any allergies you have to this medication, its components, or other substances, including foods and drugs. Describe the allergic reaction you experienced.
 Existing health conditions, such as:
+ Respiratory issues 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 certain medications for depression or Parkinson's disease, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure
 Current use of the following medications: buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine

Additional Considerations for Spinal Injection:

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

This list is not exhaustive. It is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health issues with your doctor and pharmacist to verify the safety of taking this medication. Do not initiate, stop, or adjust the dosage of any medication without consulting your doctor.
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Precautions & Cautions

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

When starting this medication, be cautious when driving or performing tasks that require alertness, as it may affect your ability to do so. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down position, and exercise caution when climbing stairs.

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

Long-term or high-dose use of this medication may lead to tolerance, where the medication becomes less effective, and higher doses may be 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.

Prolonged or regular use of opioid medications like this one can cause dependence. Suddenly stopping or reducing the dose may increase the risk of withdrawal or other severe problems. Before changing your dose or stopping the medication, consult your doctor and follow their instructions. Report any increased pain, mood changes, suicidal thoughts, or other adverse effects to your doctor.

If you have a sulfite allergy, discuss this with your doctor, as some products contain sulfites. Avoid consuming alcohol or products containing alcohol while taking this medication, as it may cause unsafe and potentially fatal effects.

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.

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 can pass into breast milk and harm your baby. Seek immediate medical attention if your baby appears excessively sleepy, limp, or has breathing difficulties.
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Overdose Information

Overdose Symptoms:

  • Severe respiratory depression (slow, shallow, or stopped breathing)
  • Extreme somnolence progressing to stupor or coma
  • Pinpoint pupils (miosis)
  • Skeletal muscle flaccidity
  • Cold, clammy skin
  • Bradycardia
  • Hypotension
  • Circulatory collapse
  • Death

What to Do:

Seek immediate emergency medical attention. Call 911 or your local emergency number. Administer naloxone if available and trained to do so. Provide respiratory support (e.g., bag-valve-mask ventilation) if breathing is severely compromised. Call 1-800-222-1222 (Poison Control Center).

Drug Interactions

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Contraindicated Interactions

  • Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of MAOI use (risk of serotonin syndrome, severe respiratory depression, coma, death)
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Major Interactions

  • Benzodiazepines and other CNS depressants (e.g., other opioids, sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, phenothiazines, alcohol) - increased risk of profound sedation, respiratory depression, coma, and death.
  • Serotonergic drugs (e.g., SSRIs, SNRIs, TCAs, triptans, mirtazapine, tramadol, fentanyl, St. John's Wort) - risk of serotonin syndrome.
  • Mixed opioid agonist/antagonists (e.g., butorphanol, nalbuphine, pentazocine) - may precipitate withdrawal symptoms or reduce analgesic effect.
  • Opioid antagonists (e.g., naltrexone, naloxone) - may precipitate acute withdrawal.
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Moderate Interactions

  • Anticholinergic drugs (e.g., atropine, scopolamine, tricyclic antidepressants) - increased risk of urinary retention and/or severe constipation.
  • Diuretics - may reduce the efficacy of diuretics due to ADH release.
  • Antihypertensives - additive hypotensive effects.
  • Cimetidine - may increase morphine levels due to inhibition of metabolism.
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Minor Interactions

  • Not readily categorized as minor due to the significant impact of most interactions.

Monitoring

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Baseline Monitoring

Pain assessment (intensity, character, location)

Rationale: To establish baseline pain level 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 score

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

Timing: Prior to first dose

Blood pressure and heart rate

Rationale: To assess baseline cardiovascular status, as opioids can cause hypotension and bradycardia.

Timing: Prior to first dose

Renal and hepatic function tests (BUN, creatinine, LFTs)

Rationale: To identify impairment that may necessitate dose adjustment due to altered metabolism/excretion.

Timing: Prior to initiation, especially in at-risk patients

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Routine Monitoring

Pain assessment

Frequency: Every 1-2 hours initially, then every 2-4 hours or as needed based on patient response and route of administration.

Target: Patient-specific, aiming for acceptable pain relief with minimal side effects.

Action Threshold: Inadequate pain control (consider dose increase or alternative), excessive pain control (consider dose decrease or extended interval).

Respiratory rate and depth

Frequency: Every 15-30 minutes for 1-2 hours after IV dose, then every 1-4 hours or as clinically indicated. Continuous monitoring for high-risk patients.

Target: >10-12 breaths/minute (adults), age-appropriate for pediatrics, regular rhythm.

Action Threshold: <10 breaths/minute (adults), shallow breathing, irregular rhythm, signs of hypoventilation (e.g., cyanosis, decreased SpO2) - intervene immediately (naloxone, respiratory support).

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

Frequency: Every 15-30 minutes for 1-2 hours after IV dose, then every 1-4 hours or as clinically indicated.

Target: Awake and alert or mildly drowsy, easily aroused.

Action Threshold: Difficult to arouse, somnolent, unarousable - intervene immediately (naloxone, respiratory support).

Blood pressure and heart rate

Frequency: Every 1-4 hours or as clinically indicated.

Target: Within patient's normal range.

Action Threshold: Significant hypotension or bradycardia - consider dose reduction, fluid administration, or vasopressors.

Bowel function

Frequency: Daily

Target: Regular bowel movements (at least every 2-3 days).

Action Threshold: Constipation (no bowel movement for >3 days) - initiate bowel regimen.

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Symptom Monitoring

  • Nausea and vomiting
  • Pruritus
  • Urinary retention
  • Dizziness
  • Confusion
  • Miosis (pupil constriction)
  • Tolerance (decreased effect over time)
  • Physical dependence (withdrawal symptoms upon abrupt cessation)

Special Patient Groups

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Pregnancy

Use during pregnancy is generally not recommended unless the potential benefit justifies the potential risk to the fetus. Prolonged use can lead to neonatal opioid withdrawal syndrome.

Trimester-Specific Risks:

First Trimester: Limited data, but potential for congenital malformations cannot be ruled out. Avoid if possible.
Second Trimester: Risk of neonatal opioid withdrawal syndrome with prolonged use.
Third Trimester: High risk of neonatal opioid withdrawal syndrome if used chronically. Risk of respiratory depression in the neonate if used close to delivery.
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Lactation

Morphine is excreted into breast milk. Use with caution. Monitor infants for signs of sedation, respiratory depression, and poor feeding. Short-term, single-dose use may be acceptable, but chronic use is generally discouraged.

Infant Risk: L3 (Moderate risk) - Potential for sedation, respiratory depression, constipation, and poor feeding in the infant. Risk is higher with higher maternal doses, prolonged use, or in preterm/neonatal infants.
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Pediatric Use

Highly variable dosing based on age, weight, and indication. Neonates and young infants are particularly sensitive to respiratory depressant effects due to immature metabolism and blood-brain barrier. Close monitoring is essential. Not recommended for routine use in neonates.

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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/hepatic function. Monitor closely for adverse effects.

Clinical Information

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Clinical Pearls

  • Always have naloxone readily available when administering morphine, especially in opioid-naïve patients or when titrating doses.
  • Monitor respiratory rate and sedation level frequently, particularly during the first hour after IV administration and after dose increases.
  • Be aware of the potential for accumulation of active metabolites (M6G) in patients with renal impairment, leading to prolonged and exaggerated opioid effects.
  • Tolerance and physical dependence can develop with prolonged use; do not abruptly discontinue in dependent patients to avoid withdrawal symptoms.
  • Educate patients and caregivers on the signs of respiratory depression and overdose, and the importance of safe storage and disposal.
  • Consider a bowel regimen (stool softener + stimulant laxative) proactively for patients on chronic opioid therapy to prevent opioid-induced constipation.
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Alternative Therapies

  • Other strong opioid agonists (e.g., hydromorphone, fentanyl, oxycodone)
  • Moderate opioid agonists (e.g., codeine, tramadol)
  • NSAIDs (e.g., ibuprofen, ketorolac) for mild to moderate pain
  • Acetaminophen for mild to moderate pain
  • Regional anesthesia/nerve blocks
  • Non-pharmacological pain management (e.g., physical therapy, heat/cold, massage, TENS)
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Cost & Coverage

Average Cost: $10 - $50 per 1ml vial (2mg/ml)
Generic Available: Yes
Insurance Coverage: Tier 1 or 2 (Generic)
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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, never share your medication with others, and do not take medication prescribed to someone else. 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 correct disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area.

This medication is accompanied by a Medication Guide, which provides crucial information for safe 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 administered to help treat the condition. 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.