Morphine Sulf 100mg/5ml(20mg/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 mu-receptor 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 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. Because it is a strong medicine, it can cause serious side effects, including slow breathing and addiction, so it's very important to use it exactly as prescribed.
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. It is essential to note that injecting or snorting this medication 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 only the measuring device that comes with the medication.
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 a bathroom. To ensure safety, store the medication in a secure location where children cannot see or reach it, and where others cannot access it. Consider using a locked box or area to safeguard the medication. Keep all medications out of reach of pets.
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. If you have questions about the best way to dispose of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missing a Dose
If you take this medication on a regular schedule and miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, do not take it more frequently than directed by 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. It is essential to note that injecting or snorting this medication 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 only the measuring device that comes with the medication.
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 a bathroom. To ensure safety, store the medication in a secure location where children cannot see or reach it, and where others cannot access it. Consider using a locked box or area to safeguard the medication. Keep all medications out of reach of pets.
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. If you have questions about the best way to dispose of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs available in your area.
Missing a Dose
If you take this medication on a regular schedule and miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at the same time or take extra doses. If you take this medication as needed, do not take it more frequently than directed by your doctor.
Lifestyle & Tips
- Do not drink alcohol or use other sedating medications while taking morphine, as this 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.
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: 10-30 mg every 4 hours as needed for pain. Adjust dose based on patient response and tolerability.
Dose Range:
10 - 30 mg
Condition-Specific Dosing:
opioid_naive:
Start with lower doses (e.g., 10-15 mg every 4 hours).
chronic_pain_conversion:
Dose must be individualized and carefully titrated when converting from other opioids.
Pediatric Dosing
Neonatal:
Not established for routine use; extreme caution and specialized monitoring required if used.
Infant:
Not established for routine use; extreme caution and specialized monitoring required if used. Dosing typically 0.1-0.2 mg/kg/dose every 4 hours, but highly individualized.
Child:
0.2-0.5 mg/kg/dose every 4 hours (max 15 mg/dose initially), titrate to effect. Max 20 mg/dose. Not for routine use in children under 6 months.
Adolescent:
Similar to adult dosing, but start with lower doses and titrate carefully.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment, but monitor for increased effects.
Moderate:
Reduce initial dose by 25-50%; extend dosing interval. Monitor closely.
Severe:
Reduce initial dose by 50-75%; extend dosing interval significantly (e.g., every 6-8 hours or longer). Avoid if possible.
Dialysis:
Morphine and its active metabolite (M6G) are dialyzable. Administer after dialysis. Significant dose reduction required.
Hepatic Impairment:
Mild:
No specific adjustment, but monitor for increased effects.
Moderate:
Reduce initial dose by 25-50%. Monitor closely.
Severe:
Reduce initial dose by 50-75%. Avoid if possible. Monitor closely for respiratory depression and sedation.
Pharmacology
Mechanism of Action
Morphine is a full opioid agonist that binds to and activates mu-opioid receptors in the central nervous system (CNS), primarily in the brain and spinal cord. This binding leads to inhibition of ascending pain pathways, altering the perception of and response to pain. It also produces generalized CNS depression, respiratory depression, miosis, decreased gastrointestinal motility, and euphoria.
Pharmacokinetics
Absorption:
Bioavailability:
20-40% (oral, highly variable due to first-pass metabolism)
Tmax:
15-60 minutes (oral solution)
FoodEffect:
Food may delay absorption but does not significantly affect the extent of absorption.
Distribution:
Vd:
3-4 L/kg
ProteinBinding:
30-35%
CnssPenetration:
Limited (due to P-glycoprotein efflux), but sufficient to exert CNS effects.
Elimination:
HalfLife:
2-4 hours (parent drug); M6G has a longer half-life (3-5 hours) and accumulates in renal impairment.
Clearance:
Not available (highly variable)
ExcretionRoute:
Renal (primarily as glucuronide conjugates, ~90%), fecal (~10%)
Unchanged:
<10% (in urine)
Pharmacodynamics
OnsetOfAction:
15-30 minutes (oral solution)
PeakEffect:
30-60 minutes (oral solution)
DurationOfAction:
3-5 hours (oral solution)
Safety & Warnings
BLACK BOX WARNING
RISK OF ADDICTION, ABUSE, AND MISUSE; RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS. 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. Serious, life-threatening, or fatal respiratory depression may occur. Accidental ingestion of even one dose of morphine, especially by children, can result in a fatal overdose. Prolonged use of morphine 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 CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate. If concurrent use is necessary, reduce the dose and duration of concomitant use to the minimum required and follow patients for signs and symptoms of respiratory depression and sedation. The concomitant use of morphine with all cytochrome P450 3A4 inhibitors may result in increased plasma concentrations of morphine, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in increased plasma concentration of morphine. Monitor patients receiving morphine and any CYP3A4 inhibitor or inducer.
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 immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness or lightheadedness
+ Headache or feeling sleepy or weak
+ Shaking, fast heartbeat, confusion, hunger, or sweating
Severe dizziness or fainting
Chest pain or pressure, or a rapid heartbeat
Confusion or disorientation
Breathing difficulties, such as:
+ Slow or shallow breathing
+ Noisy breathing
+ Sleep apnea (breathing problems during sleep)
Seizures
Severe constipation or stomach pain, which may indicate a bowel problem
Depression or 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 or changes in balance
+ Confusion or hallucinations
+ Fever or rapid heartbeat
+ Flushing or muscle twitching or stiffness
+ Seizures or shivering and shaking
+ Excessive sweating or 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 or severe dizziness
+ Severe nausea, vomiting, or decreased appetite
Hormonal changes, which may occur with long-term opioid use. Symptoms include:
+ Decreased sex drive
+ Fertility problems or irregular menstrual periods
+ Ejaculation problems
Other Possible Side Effects
Most people taking this medication will not experience severe side effects. However, some may encounter mild or moderate side effects, including:
Dizziness, drowsiness, fatigue, or weakness
Dry mouth
Constipation, diarrhea, stomach pain, nausea, vomiting, or decreased appetite
Headache
Anxiety
Excessive sweating
If you experience any of these side effects or any other unusual symptoms, contact your doctor for advice. 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 notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness or lightheadedness
+ Headache or feeling sleepy or weak
+ Shaking, fast heartbeat, confusion, hunger, or sweating
Severe dizziness or fainting
Chest pain or pressure, or a rapid heartbeat
Confusion or disorientation
Breathing difficulties, such as:
+ Slow or shallow breathing
+ Noisy breathing
+ Sleep apnea (breathing problems during sleep)
Seizures
Severe constipation or stomach pain, which may indicate a bowel problem
Depression or 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 or changes in balance
+ Confusion or hallucinations
+ Fever or rapid heartbeat
+ Flushing or muscle twitching or stiffness
+ Seizures or shivering and shaking
+ Excessive sweating or 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 or severe dizziness
+ Severe nausea, vomiting, or decreased appetite
Hormonal changes, which may occur with long-term opioid use. Symptoms include:
+ Decreased sex drive
+ Fertility problems or irregular menstrual periods
+ Ejaculation problems
Other Possible Side Effects
Most people taking this medication will not experience severe side effects. However, some may encounter mild or moderate side effects, including:
Dizziness, drowsiness, fatigue, or weakness
Dry mouth
Constipation, diarrhea, stomach pain, nausea, vomiting, or decreased appetite
Headache
Anxiety
Excessive sweating
If you experience any of these side effects or any other unusual symptoms, contact your doctor for advice. 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 disorientation
- Severe constipation or abdominal pain
- Signs of an allergic reaction (rash, itching, swelling of face/tongue/throat)
- Pinpoint pupils
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is crucial to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced.
Certain health conditions, such as:
+ Respiratory problems, including 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, including 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 essential to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure safe use. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
It is crucial to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced.
Certain health conditions, such as:
+ Respiratory problems, including 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, including 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 essential to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure safe use. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
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, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.
Do not combine this medication with other strong pain relievers or use it with 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. Adhere to the prescribed dosage and do not take more than ordered.
Long-term or high-dose use of this medication can lead to tolerance, where the drug becomes less effective, and higher doses may be required to achieve the same effect. If you find that this medication is no longer working as well as it did initially, consult your doctor. Do not exceed the prescribed dose.
Prolonged or regular use of opioid medications like this one can result in dependence. Suddenly reducing the dose or stopping the medication altogether may increase the risk of withdrawal or other severe complications. Before decreasing the dose or discontinuing this medication, consult your doctor and follow their instructions. Report any increased pain, mood changes, suicidal thoughts, or other adverse effects to your doctor.
Avoid consuming alcohol or products containing alcohol while taking this medication, as this can lead to unsafe and potentially fatal consequences.
This medication may increase the risk of seizures in certain individuals, particularly those with a history of seizures. Discuss your risk of seizures with your doctor.
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 potentially harm your baby. Seek immediate medical attention if your baby appears excessively sleepy, limp, or has breathing difficulties.
When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.
Do not combine this medication with other strong pain relievers or use it with 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. Adhere to the prescribed dosage and do not take more than ordered.
Long-term or high-dose use of this medication can lead to tolerance, where the drug becomes less effective, and higher doses may be required to achieve the same effect. If you find that this medication is no longer working as well as it did initially, consult your doctor. Do not exceed the prescribed dose.
Prolonged or regular use of opioid medications like this one can result in dependence. Suddenly reducing the dose or stopping the medication altogether may increase the risk of withdrawal or other severe complications. Before decreasing the dose or discontinuing this medication, consult your doctor and follow their instructions. Report any increased pain, mood changes, suicidal thoughts, or other adverse effects to your doctor.
Avoid consuming alcohol or products containing alcohol while taking this medication, as this can lead to unsafe and potentially fatal consequences.
This medication may increase the risk of seizures in certain individuals, particularly those with a history of seizures. Discuss your risk of seizures with your doctor.
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 potentially harm your baby. Seek immediate medical attention if your baby appears excessively sleepy, limp, or has breathing difficulties.
Overdose Information
Overdose Symptoms:
- Slowed or stopped breathing (respiratory depression)
- Extreme drowsiness, unresponsiveness, or coma
- Pinpoint pupils
- Cold, clammy skin
- Limp muscles
- Bluish discoloration of lips and fingernails (cyanosis)
- Slowed heart rate
- Low blood pressure
What to Do:
Seek immediate emergency medical attention. Call 911 or your local emergency number. If naloxone (Narcan) is available and you are trained to use it, administer it as directed. Stay with the person until emergency help arrives. Call 1-800-222-1222 (Poison Control) for additional guidance.
Drug Interactions
Contraindicated Interactions
- Monoamine Oxidase Inhibitors (MAOIs) within 14 days
Major Interactions
- Benzodiazepines and other CNS depressants (e.g., other opioids, alcohol, sedatives, hypnotics, general anesthetics, phenothiazines, tranquilizers, skeletal muscle relaxants, gabapentinoids)
- Serotonergic drugs (e.g., SSRIs, SNRIs, TCAs, triptans, mirtazapine, tramadol, fentanyl, St. John's Wort)
- Mixed agonist/antagonist opioids (e.g., pentazocine, nalbuphine, butorphanol)
- Partial agonist opioids (e.g., buprenorphine)
Moderate Interactions
Minor Interactions
- Metoclopramide (may antagonize GI effects)
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 impairment that may require dose adjustment.
Timing: Prior to initiation of therapy, especially in at-risk patients
Routine Monitoring
Pain assessment
Frequency: Regularly, as clinically indicated (e.g., prior to each dose, 30-60 minutes post-dose, or daily for chronic pain)
Target: Acceptable pain level as defined by patient
Action Threshold: Uncontrolled pain, requiring dose adjustment or alternative therapy
Respiratory rate and depth
Frequency: Regularly, especially during initiation and dose titration (e.g., every 1-4 hours initially, then daily for stable patients)
Target: >10-12 breaths/minute (adults), regular rhythm
Action Threshold: <10 breaths/minute, shallow breathing, cyanosis, somnolence; administer naloxone if indicated
Level of consciousness/sedation (e.g., Pasero Opioid-Induced Sedation Scale)
Frequency: Regularly, especially during initiation and dose titration (e.g., every 1-4 hours initially, then daily for stable patients)
Target: Alert or mildly drowsy, easily aroused
Action Threshold: Difficult to arouse, somnolent, unarousable; hold dose, consider naloxone
Bowel function
Frequency: Daily
Target: Regular bowel movements (e.g., every 1-2 days)
Action Threshold: Constipation, abdominal distension, nausea; initiate or adjust bowel regimen
Signs of opioid-induced hyperalgesia
Frequency: Periodically, especially with long-term use or dose escalation
Target: Pain relief without increased sensitivity to pain
Action Threshold: Worsening pain despite dose escalation, diffuse pain, allodynia; consider dose reduction, opioid rotation, or alternative analgesics
Symptom Monitoring
- Respiratory depression (slow, shallow breathing)
- Excessive sedation/somnolence
- Dizziness, lightheadedness
- Nausea, vomiting
- Constipation
- Pruritus (itching)
- Urinary retention
- Confusion, disorientation
- Signs of allergic reaction (rash, hives, swelling)
Special Patient Groups
Pregnancy
Prolonged use of morphine during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS) in the newborn, which may be life-threatening if not recognized and treated. Morphine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Discuss risks and benefits with a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Limited data, but potential for congenital malformations cannot be ruled out. Risk of NOWS if continued.
Second Trimester:
Risk of NOWS if continued.
Third Trimester:
High risk of NOWS, respiratory depression, and withdrawal symptoms in the neonate. Monitor neonates for signs of NOWS for several days after birth.
Lactation
Morphine is excreted into breast milk. Infants exposed to morphine through breast milk are at risk for serious adverse reactions, including excess sedation and respiratory depression. Monitor infants for signs of sedation, respiratory depression, and poor feeding. If opioid use is necessary, use the lowest effective dose for the shortest duration. Consider alternative analgesics or temporary cessation of breastfeeding.
Infant Risk:
Moderate to High (L3-L4), depending on dose, duration, and infant age/health. Higher risk in preterm or neonates.
Pediatric Use
Use with extreme caution, especially in infants and young children, due to increased sensitivity to respiratory depression and variable metabolism. Dosing must be individualized and carefully titrated based on weight and clinical response. Not recommended for routine use in children under 6 months.
Geriatric Use
Elderly patients may be more sensitive to the analgesic and adverse effects of morphine, particularly respiratory depression. Start with lower doses and titrate slowly. Monitor closely for sedation, respiratory depression, and constipation. Renal and hepatic impairment are more common in the elderly, requiring further dose adjustments.
Clinical Information
Clinical Pearls
- Morphine oral solution (20 mg/mL) is a concentrated formulation; ensure accurate measurement to avoid overdose. Use an oral syringe or calibrated measuring device.
- Always assess pain level, sedation, and respiratory status before and after administering morphine.
- Opioid-induced constipation is a common and often persistent side effect; proactive bowel regimen (stimulant laxative + stool softener) should be initiated with the first dose.
- Tolerance and physical dependence can develop with chronic use. Do not abruptly discontinue morphine in physically dependent patients to avoid withdrawal symptoms.
- Naloxone should be readily available for reversal of life-threatening respiratory depression.
- Educate patients and caregivers on safe storage and disposal of unused medication to prevent accidental ingestion and diversion.
Alternative Therapies
- Other opioid analgesics (e.g., oxycodone, hydromorphone, fentanyl, hydrocodone)
- Non-opioid analgesics (e.g., NSAIDs, acetaminophen) for mild to moderate pain
- Adjuvant analgesics (e.g., gabapentin, pregabalin, tricyclic antidepressants) for neuropathic pain
- Regional anesthesia or nerve blocks
- Non-pharmacological pain management (e.g., physical therapy, acupuncture, cognitive behavioral therapy)
Cost & Coverage
Average Cost:
Varies widely per 100mg/5ml bottle
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, 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 regarding 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, 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 regarding 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.