Generic
Morphine Sulphate
7 brands available in the market
At a glance
Morphine Sulphate is an opioid analgesic used for the treatment of severe acute and chronic pain. It binds to opioid receptors in the central nervous system to alter pain perception.
Description
Morphine is a phenanthrene derivative which acts mainly on the CNS and smooth muscles. It binds to opiate receptors in the CNS altering pain perception and response. Analgesia, euphoria and dependence are due to its action at the mu-1 receptors while respiratory depression and inhibition of intestinal movements are due to action at the mu-2 receptors.
Indications
- Severe acute and chronic pain
- Pain associated with myocardial infarction
- Unstable angina
- Intractable cough
- Acute pulmonary oedema
- Analgesia during labour
- Post-operative pain
Therapeutic class
Opioid Analgesics
Pharmacological class
Mu Opioid Receptor Agonist
Pharmacology
Morphine binds to opioid receptors in the CNS altering pain perception and response. It produces analgesia at mu-1 receptors and respiratory depression & inhibition of intestinal movements at mu-2 receptors. Spinal analgesia is mediated by agonist action at the K receptor.
Mechanism of action
Alters pain perception and provides pain relief by activating opioid receptors.
Dosage
Adult Dose (Oral):
- Moderate-severe pain: 5-20 mg every 4 hours
- Extended-release: 5-20 mg every 12 hours
- Severe pain: 30 mg every 12 hours (retard tablet)
- Post-operative pain: 30 mg every 12 hours for patients >70 kg
Pediatric Dose (Oral):
- 3-5 years: 5 mg every 4 hours
- 6-12 years: 5-10 mg every 4 hours
- 13-18 years: 5-20 mg every 4 hours
- Cancer pain: 0.2-0.8 mg/kg every 12 hours
Parenteral: IM/SC: 5-20 mg; IV: 2.5-10 mg over 4-5 minutes
Administration
- May be taken with or without food
- Extended-release tablets should be swallowed whole; do not crush or chew
- Oral solution: Use measured dropper or syringe
- IV administration: Administer slowly over 4-5 minutes
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Common Side Effects (>10%):
- Pruritus (≤80%)
- Urinary retention (15-70%)
- Vomiting (7-70%)
- Constipation (>10%)
- Headache (>10%)
- Somnolence (>10%)
Uncommon (1-10%):
- Abdominal pain, asthenia, backache, depression, diarrhea, dyspnea, fever, insomnia, loss of appetite, nausea, paresthesia, peripheral edema, rash, sweating, xerostomia
Rare: Anaphylaxis, cardiac arrest, circulatory depression, shock, vertigo
Precautions & warnings
- Caution in patients with impaired respiratory function, severe bronchial asthma, convulsive disorders, acute alcoholism, delirium tremens, raised intracranial pressure, hypotension, cardiac arrhythmias, severe cor pulmonale, history of substance abuse
- Dose reduction may be needed in renal and hepatic impairment
- May impair ability to drive or operate machinery
- Long-term use may lead to dependence
- Abrupt cessation may cause withdrawal symptoms
Contraindications
- Respiratory depression
- Acute or severe asthma
- Paralytic ileus
- Obstructive airway disease
- Acute liver disease
- Comatose patients
- Increased intracranial pressure
- Acute alcoholism
- Hypersensitivity
Drug interactions
- Additive depressant effects with other CNS depressants (sedatives, hypnotics, general anaesthetics, phenothiazines)
- Potentially fatal interaction with MAOIs
- Cimetidine increases plasma concentrations
- Mixed agonist/antagonists (pentazocine, nalbuphine, buprenorphine) reduce analgesic effect
- May reduce efficacy of diuretics
Food interactions
May be taken with food to reduce GI discomfort.
Use in pregnancy
Use in Pregnancy: Pregnancy category C; Category D with prolonged use/high doses at term. Not recommended during pregnancy and labour due to risk of neonatal respiratory depression.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Morphine is excreted in breast milk; use in nursing mothers is not recommended.
Pediatric use
Not recommended for children under 3 years; doses established for 3-18 years.
Geriatric use
Elderly should start with half the adult dose.
Renal / hepatic impairment
Renal Impairment: Dose reduction may be needed in kidney disease.
Hepatic Impairment: Dose reduction may be needed in liver disease.
Overdose effects
Overdose: Pin-point pupils, skeletal muscle flaccidity, bradycardia, respiratory depression, hypotension, somnolence, coma; naloxone as antidote.
Storage conditions
Store in a cool and dry place, protected from light; keep out of reach of children.
Chemical structure
Morphine Sulphate