- Pain:
- IV/SC:
- Child 1-5 months:
- Initially SC 100-200mcg/kg QID, adjusted according to response OR
-
-
- IV 100mcg/kg QID administered over 5 minutes OR IV 100mcg/kg QID administered over 5 minutes then 10-30mcg/kg/hour by continuous infusion
-
-
- Child 6 months-1 year:
- Initially SC 100-200mcg/kg every 4 hours, adjusted according to response OR
- Child 6 months-1 year:
-
-
- IV 100mcg/kg every 4 hours administered over 5 minutes OR IV 100mcg/kg every 4 hours administered over 5 minutes then 20-30mcg/kg/hour by continuous infusion
-
-
- Child 2-11 years:
- Initially SC 200mcg/kg every 4 hours, adjusted according to response
- Child 2-11 years:
-
- Child 12-17 years:
- Initially SC 2.5-10mg every 4 hours, adjusted according to response OR
- Child 12-17 years:
-
-
- IV 5mg every 4 hours administered over at least 5 minutes OR IV 5mg/kg every 4 hours administered over 5 minutes then 20-30mcg/kg/hour by continuous infusion
- IV 5mg every 4 hours administered over at least 5 minutes OR IV 5mg/kg every 4 hours administered over 5 minutes then 20-30mcg/kg/hour by continuous infusion
-
-
- PO/PR:
- Child 1-2 months: PO/PR 50-100mcg/kg every 4 hours
- Child 3-5 months: PO/PR 100-150mcg/kg every 4 hours
- Child 6-11 months: PO/PR 200mcg/kg every 4 hours
- Child 1 year: PO/PR 200-300mcg/kg every 4 hours
- Child 2-11 years: PO/PR 200–300mcg/kg every 4 hours (max per dose: 10 mg)
- Child 12-17 years: PO/PR 5-10mg every 4 hours
- PO/PR:
- Acute pain:
- PO/SC/IM:
- Adult: Initially 10mg every 4 hours
- Elderly: Initially 5mg every 4 hours
- SC not suitable for edematous patients
- Dose can be given more frequently during titration
- PO/SC/IM:
- Chronic pain:
- Adult: PO/SC/IM initially 5-10mg every 4 hours OR PR 15-30 mg every 4 hours
- SC not suitable for edematous patients
- Pain management in palliative care (starting dose for opioid-naïve patient):
- Adult: PO 20-30mg daily in divided doses
- Immediate-release preparation 4-hourly or a 12-hourly modified-release preparation
- Adult: PO 20-30mg daily in divided doses
- Pain management in palliative care (starting dose for patients being switched from a regular weak opioid):
- Adult: PO 40-60mg daily in divided doses
- Using immediate-release preparation 4-hourly or 12-hourly modified-release preparation
- Pain in palliative care (following initial titration):
- Adult (immediate release): PO 30mg every 4 hours
- Up to 200mg every 4 hours
- Adult (immediate release): PO 30mg every 4 hours
- Adult (moderate release): PO 100 mg BD
- Up to 600mg every 12 hours
- Higher dose may be required for some patients (occasionally more is needed)
- Cough in palliative care:
- Adult: PO initially 5mg every 4 hours
- Premedication:
- Adult: SC/IM up to 10mg
- Dose to be administered 60-90 minutes before operation
- Patient controlled analgesia (PCA):
- <50kg: Loading dose: IV 0.04mg/kg/dose *1 then 0.1-0.03mg/kg/dose every 6-20min PRN
- Max: 0.15mg/kg/hour
- >50kg: Loading dose: IV 1-5mg *1 then 0.5-2.5mg every 6-20min PRN
- <50kg: Loading dose: IV 0.04mg/kg/dose *1 then 0.1-0.03mg/kg/dose every 6-20min PRN
- Myocardial infarction:
- IV 2-5mg every 5-30min
- Some patients require maintenance dose at IV 4-8mg every 4-6 hours
- Adjunct treatment in pulmonary edema:
- IV 1-3mg every 5min
- IV 1-3mg every 5min
- Dyspnea:
- PO 5-10mg every 4 hours PRN OR
-
- SC/IV 2-10mg every 4 hours PRN
- Tablet/capsule:
- 10mg
- 30mg
- Injection:
- 10mg/mL
- 30mg/mL
- Taper dose gradually by 25-50% every 2 to 4 days when discontinuing monitoring for symptoms of withdrawal
- Opioid-tolerant patients may require higher initial doses
- Usual dosage of IV morphine in adults, regardless of indication, is 2-10mg/70 kg body weight
Opioid
It binds to various opioid receptors, producing analgesia and sedation
- Somnolence
- Constipation
- Nausea
- Vomiting
- Dizziness
- Diaphoresis
- Dysphoria
- Euphoria
- Headache
- Edema
- Abdominal pain
- Pruritus
- Flushing
- Xerostomia
- Asthenia
- Paresthesia
- Urinary retention
- Decreased libido
- Miosis
- Flatulence (peds patients)
- Oxygen saturation decreased (peds patients)
- Hypersensitivity to class/components
- Paralytic ileus
- Toxin-mediated diarrhea
- Respiratory depression
- Acute or severe bronchial asthma
- Upper airway obstruction
- Within 2 weeks of (MAOI) therapy
- GI obstruction (extended release)
- Hypercarbia (immediate release tablets/solution)
- Upper airway obstruction (epidural/intrathecal)
- Heart failure due to chronic lung disease
- Head injuries
- Brain tumors
- Deliriums tremens
- Impaired consciousness
- Coma
- Circulatory shock
- Seizure disorders
- During labor when premature birth anticipated (injectable formulation)
- Labor and delivery (PO form)
- Cardiac arrhythmia
- Increased intracranial or cerebrospinal pressure
- Acute alcoholism
- Use after biliary tract surgery
- Surgical anastomosis (suppository formulation)
WARNING
- Morphine concentrated oral solution (100 mg per 5 mL) indicated only in opioid-tolerant adult patients
- Opioid agonist Schedule II controlled substance with risk of addiction, abuse and misuse, which can lead to overdose and death
- Serious, life-threatening or fatal cases may occur even with recommended use
- Accidental ingestion of even one dose, esp. By children, can result in fatal morphine overdose
- Prolonged maternal use of opioid treatment during pregnancy can lead to potentially life-threatening neonatal opioid withdrawal syndrome
- Concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma and death
- Isocarboxazid
- Isoniazid
- Linezolid
- Methylene blue
- Naltrexone
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Samidorphan
- Selegiline
- Tipranavir
- Tranylcypromine
- Yohimbe
Drug Status
Availability | Prescription only |
Pregnancy | Weigh risk vs benefit |
Breastfeeding | Weigh risk vs benefit |
Schedule | Controlled |
BRAND NAME | STRENGTH | FORMULATION | PACK SIZE | MANUFACTURER | DISTRIBUTOR |
---|---|---|---|---|---|
Morphine Sulphate | 1% w/v | Injection | 10’s | Macarthys Labs | Laborex Kenya |
Morphine Sulphate | 3% w/v | Injection | 10’s | Macarthys Labs | Laborex Kenya |
Morphine Sulphate Fresenius | 1% w/v | Injection | 10’s | Fresenius Kabi | Surgipharm Ltd |
MST Continus | 10mg | Tablet | 60’s | Modi Mundipharma | Europa Healthcare |
MST Continus | 30mg | Tablet | 60’s | Modi Mundipharma | Europa Healthcare |
MST Continus | 60mg | Tablet | 60’s | Modi Mundipharma | Europa Healthcare |
Vermor | 1% w/v | Injection | 10’s | M/S Verve Human Care | Generics Africa |
Vermor | 10mg | Tablet | 100’s | M/S Verve Human Care | Generics Africa |
Zomorph | 10mg | Capsule | 60’s | Ethypharm | Laborex Kenya |
Zomorph | 30mg | Capsule | 60’s | Ethypharm | Laborex Kenya |