Morphine Sulfate

A to Z Drug Facts

(moRE-feen SULL-fate)

Astramorph PF, Duramorph, Infumorph, Kadian, MS Contin, MSIR, Oramorph SR, OMS Concentrate, RMS, Roxanol, Roxanol Rescudose, Roxanol 100, Roxanol T, Roxanol UD,  M-Eslon, M.O.S.-Sulfate, Statex

Class: Narcotic analgesic

 Action Relieves pain by stimulating opiate receptors in CNS; also causes respiratory depression, peripheral vasodilation, inhibition of intestinal peristalsis, sphincter of Oddi spasm, stimulation of chemoreceptors that cause vomiting and increased bladder tone.

 Indications Relief of moderate to severe acute and chronic pain; relief of pain in patients who require opioid analgesics for more than a few days (sustained release only); management of pain not responsive to nonnarcotic analgesics; yspnea associated with acute left ventricular failure and pulmonary edema; reoperative sedation; adjunct to anesthesia; analgesia during labor.

 Contraindications Hypersensitivity to opiates; upper airway obstruction; acute asthma; iarrhea caused by poisoning or toxins.

Injection: Heart failure secondary to chronic lung disease; cardiac arrhythmias; rain tumor; acute alcoholism; delirium tremens; idiosyncrasy to the drug; onvulsive states (eg, status epilepticus, tetanus, strychnine poisoning). Immediate-release oral solution: Respiratory insufficiency; severe CNS depression; heart failure secondary to chronic lung disease; cardiac arrhythmias; increased intracranial or cerebrospinal pressure; head injuries; brain tumor; acute alcoholism; delirium tremens; onvulsive disorders; after biliary tract surgery; suspected surgical abdomen; urgical anastomosis; idiosyncrasy to the drug; concomitantly with MAO inhibitors or within 14 days of such treatment. Intrathecal/epidural: Infection at injection site; anticoagulation; bleeding condition; parenteral corticosteroids within past 2 wk; any other drug or condition that would contraindicate intrathecal/epidural therapy.

 Route/Dosage

ADULTS: PO 10 to 30 mg q 4 hr prn. SC/IM 5 to 20 mg/70 kg q 4 hr prn. IV 2.5 to 15 mg/70 kg in 4 to 5 ml Water for Injection over 5 min prn. IV (open-heart surgery) 0.5 to 3 mg/kg. IV (MI pain) 8 to 15 mg; for very severe pain, additional smaller doses may be given q 3 to 4 hrs. PR 10 to 20 mg q 4 hr prn. Epidural Initial injection: 5 mg may provide pain relief for up to 24 hr; if pain is not controlled within 1 hr, give incremental doses of 1 to 2 mg. Do not exceed 10 mg/24 hr. Intrathecal Usual dose is 10% of epidural dose. Single injection of 0.2–1 mg may provide pain relief for 24 hr. Do not inject more than 2 ml of 5 mg/10 ml ampul or 1 ml of 10 mg/10 ml ampul. Repeat injections not recommended. CHILDREN: SC/IM 0.1 to 0.2 mg/kg q 4 hr. Maximum dose: 15 mg.

 Interactions

CNS depressants (eg, alcohol, sedatives, tranquilizers): Additive CNS depression. Antihistamines, chloral hydrate, glutethimide, methocarbamol: Depressant effects of morphine may be enhanced. Cimetidine: Monitor for increased respiratory and CNS depression. Concomitant administration of cimetidine and morphine has been reported to precipitate apnea, confusion, and muscle twitching in an isolated report. Clomipramine, nortriptyline, amitriptyline: Monitor for increased CNS and respiratory depression when administered with morphine. INCOMPATIBILITIES: Acyclovir, barbiturates, furosemides, heparin, sargramostim, sodium bicarbonate: Precipitation of IV solutions.

 Lab Test Interferences Increased amylase and lipase may occur up to 24 hr after dose.

 Adverse Reactions

CV: Hypotension; orthostatic hypotension; bradycardia; tachycardia; alpitations. CNS: Lightheadedness; dizziness; drowsiness; sedation; euphoria; dysphoria; elirium; disorientation; incoordination. DERM: Sweating; pruritus; urticaria. EENT: Blurred vision; miosis. GI: Nausea; vomiting; constipation; abdominal pain. GU: Urinary retention or hesitancy. RESP: Respiratory depression; apnea; respiratory arrest; laryngospasm; epression of cough reflex. OTHER: Tolerance; psychological and physical dependence with chronic use; ain at injection site; local irritation and induration following SC use.

 Precautions

Pregnancy: Category C. Labor and delivery: Therapeutic morphine doses have increased duration of labor. Lactation: Excreted in breast milk. Children: Safety not established in children. Elderly patients: Dosage reduction may be necessary. Special risk patients: Use drug with caution in patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, supraventricular tachycardia, depleted blood volume or circulatory shock. Asthma and other respiratory conditions: Bisulfites and morphine may potentiate each other, preventing use by cause severe adverse reactions. Drug dependence: Has abuse potential. Hepatic or renal impairment: May need to reduce dose.

 Administration/Storage

• Administer medication as soon as pain occurs. Effect is reduced as pain increases.
• Give oral form with food to decrease GI upset.
• Administer antiemetic for nausea and vomiting, if ordered.
• Controlled-release tablets should not be chewed or crushed.
• Prepare IV solution by diluting in 4–5 ml of Water for Injection. Administer over 4–5 min.
• For continuous IV infusion, add drug to prepare solution of 0.1–1 mg/ml in D5W. Control infusion with electronic infusion device.
• Do not administer IV solution if cloudy, precipitate is present or antidote is not readily available.
• Intrathecal and epidural injection should be administered only in lumbar region.
• To reduce chance of adverse effects with intrathecal administration, constant IV infusion of naloxone (0.6 mg/hr for 24 hr after intrathecal injection) s recommended.
• Subcutaneous injection can irritate tissues; use IM injection for repeated doses.
• Store at room temperature.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess type, location and intensity of pain before and 30–60 min after administration.
• Assess vital signs before and periodically during therapy.
• Assess bowel and bladder function regularly in patients receiving repeated doses.
• Assist patient with ambulation. Keep siderails up and call bell within reach.
• Evaluate therapeutic response. Prolonged use may lead to physical dependence and tolerance. Progressively higher doses may be necessary to control pain in patients receiving long-term therapy.
• With continuous infusion, titrate dose to ensure adequate pain relief without excessive sedation, respiratory depression or hypotension.
• Monitor for CNS changes: dizziness, drowsiness, hallucinations, euphoria, level of consciousness, pupil reaction.

 Patient/Family Education

• Instruct patient to take oral preparations with food or juice if GI upset occurs.
• Tell patient not to crush or chew controlled-release tablets.
• Explain that full effectiveness of drug may not occur for 30–60 min after administration. Emphasize that drug is more effective if taken regularly to prevent pain rather than to treat pain after it occurs.
• If patient is to receive patient-controlled analgesia (PCA), instruct on use of PCA pump.
• Explain that physical dependency may occur with long-term therapy and that dosage will be tapered slowly before stopping to prevent withdrawal symptoms (nausea, vomiting, cramps, fever, faintness, anorexia).
• Encourage patient to turn, cough and breathe deeply every 2 hr to prevent atelectasis.
• Advise patient to consult with physician if excessive sedation occurs or if pain relief is inadequate.
• Inform patient that drug may cause constipation. Stool softener, fiber laxative, increased fluid intake and bulk in diet may help alleviate problem.
• Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to avoid intake of alcoholic beverages and other CNS depressants.
• Advise patient that drug may cause drowsiness, dizziness or blurred vision and to use caution while driving or performing other tasks requiring mental alertness.
• Instruct patient not to take otc medications without consulting physician.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts