• 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
      • 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 12-17 years:
      • Initially SC 2.5-10mg every 4 hours, adjusted according to response OR
      • 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
  • 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
  • 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
  • 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 (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
  • 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
  • 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