Astramorph PF, Avinza, DepoDur, Duramorph, Epimorph , Infumorph, Kadian, MS Contin, MSIR, Oramorph SR, RMS, Roxanol, Statex
Classifications: analgesic; narcotic (opiate) agonist; Therapeutic:narcotic (opiate) analgesic
Pregnancy Category: C (D in long-term use or high dose, or close to term)
Controlled Substance: Schedule II
10 mg, 15 mg, 30 mg tablets/capsules; 10 mg, 15 mg, 20 mg, 30 mg, 50 mg, 60 mg, 90 mg, 100 mg, 120 mg, 200 mg controlled release tablets/capsules; 10 mg/2.5 mL, 10 mg/5 mL, 20 mg/mL, 20 mg/5 mL, 30 mg/1.5 mL, 100 mg/5 mL oral solution; 0.5 mg/mL, 1 mg/mL, 2 mg/mL, 4 mg/mL, 5 mg/mL, 8 mg/mL, 10 mg/mL, 15 mg/mL, 25 mg/mL, 50 mg/mL injection; 10 mg/mL extended release lysosomal injection; 5 mg, 10 mg, 20 mg, 30 mg suppositories
Natural opium alkaloid with agonist activity by binding with the same receptors as endogenous opioid peptides. Narcotic
agonist effects are identified with 3 locations of receptors: analgesia at supraspinal level, euphoria, respiratory depression
and physical dependence; analgesia at spinal level, sedation and miosis; and dysphoric, hallucinogenic, and cardiac stimulant
Controls severe pain; also used as an adjunct to anesthesia.
Symptomatic relief of severe acute and chronic pain after nonnarcotic analgesics have failed and as preanesthetic medication;
also used to relieve dyspnea of acute left ventricular failure and pulmonary edema and pain of MI.
Hypersensitivity to opiates; increased intracranial pressure; convulsive disorders; acute alcoholism; acute bronchial asthma,
chronic pulmonary diseases, severe respiratory depression; chemical-irritant induced pulmonary edema; prostatic hypertrophy;
diarrhea caused by poisoning until the toxic material has been eliminated; undiagnosed acute abdominal conditions; following
biliary tract surgery and surgical anastomosis; pancreatitis; acute ulcerative colitis; severe liver or renal insufficiency;
Addison's disease; hypothyroidism; during labor for delivery of a premature infant, in premature infants; pregnancy (category
C; D in long-term use or when high dose is used, or close to term).
Toxic psychosis; cardiac arrhythmias, cardiovascular disease; emphysema; kyphoscoliosis; cor pulmonale; severe obesity; reduced
blood volume; very old, very young, or debilitated patients; labor.
Route & Dosage
Adult: PO 1030 mg q4h prn or 1530 mg sustained release q812h; (Kadian) dose q1224h, increase dose prn for pain relief; (Avinza) dose q24h IV 2.515 mg/70 kg q24h or 0.810 mg/h by continuous infusion, may increase prn to control pain or 510
mg given epidurally q24h Epidural (DepoDur only) 1015 mg as single dose 30 min before surgery (max: 20 mg) IM/SC 520 mg q4h PR 1020 mg q4h prn
Child: IV 0.050.1 mg/kg q4h or 0.0252.6 mg/kg/h by continuous infusion (max: 10 mg/dose) IM/SC 0.10.2 mg/kg q4h (max: 15 mg/dose) PO 0.20.5 mg/kg q46h; 0.30.6 mg/kg sustained release q12h
Neonate: IV/IM/SC 0.05 mg/kg q48h (max: 0.1 mg/kg/dose) or 0.010.02 mg/kg/h
Clcr 1050 mL/min: use 75% of dose, if lower use 50% of dose
- Use a fixed, individualized schedule when narcotic analgesic therapy is started to provide effective management; blood levels
can be maintained and peaks of pain can be prevented (usually a 4-h interval is adequate).
- Use lower dosage for older adult or debilitated patients than for adults.
- Do not break in half, crush, or allow sustained release tablet to be chewed.
- Do not give patient sustained release tablet within 24 h of surgery.
- Dilute oral solution in approximately 30 mL or more of fluid or semisolid food. A calibrated dropper comes with the bottle.
Read labels carefully when using liquid preparation; available solutions: 20 mg/mL; 100 mg/mL.
- Note: Verify correct IV concentration and rate of infusion/injection for administration to neonates, infants, or children with
PREPARE: Direct: Dilute 210 mg in at least 5 mL of sterile water for injection. Continuous: Typically diluted to a range of 0.11 mg per mL. More concentrated solutions may be required with fluid restriction.
ADMINISTER: Direct: Give a single dose over 45 min. Avoid rapid administration. Continuous: Infuse via a controlled infusion device at a rate determined by patient response as ordered.
INCOMPATIBILITIES Solution/additive: Alteplase, Aminophylline, amobarbital, chlorothiazide, floxacillin, fluorouracil, haloperidol, heparin, meperidine, nitrofurantoin, pentobarbital, phenobarbital, perphenazine, phenytoin, sodium bicarbonate, thiopental. Y-site: Amphotericin B cholesteryl complex, azithromycin, cefepime, doxorubicin liposome, gallium, minocycline, phenytoin, sargramostim, tetracycline.
- Store at 15°30° C (59°86° F). Avoid freezing. Refrigerate suppositories. Protect all formulations
Adverse Effects (≥1%)Body as a Whole:
rash, urticaria, edema, hemorrhagic urticaria (rare), anaphylactoid reaction
(rare)], sweating, skeletal muscle flaccidity; cold, clammy skin, hypothermia. CNS:
, disorientation, visual disturbances, dysphoria, paradoxic CNS
stimulation (restlessness, tremor, delirium,
insomnia), convulsions (infants and children); decreased cough reflex, drowsiness, dizziness, deep sleep, coma, continuous
infusion may cause granulomas leading to paralysis. Special Senses:
Bradycardia, palpitations, syncope; flushing of face, neck, and upper thorax; orthostatic hypotension, cardiac arrest. GI: Constipation,
anorexia, dry mouth, biliary colic, nausea,
vomiting, elevated transaminase
Urinary retention or urgency, dysuria, oliguria, reduced libido or potency (prolonged use). Other:
Prolonged labor and respiratory depression
of newborn. Hematologic:
Precipitation of porphyria. Respiratory: Severe respiratory depression
(as low as 24/min) or arrest
Diagnostic Test Interference
False-positive urine glucose determinations may occur using Benedict's solution. Plasma amylase and lipase determinations may be falsely positive for 24 h after use of morphine; transaminase levels may be elevated.
InteractionsDrug: cns depressants
, and tricyclic antidepressants
depressant effects. Use mao inhibitors
cautiously; they may precipitate hypertensive crisis. phenothiazines
may antagonize analgesia. Use with alcohol
may lead to potentially fatal overdoses. Herbal: Kava, valerian, St. John's wort
may increase sedation.
Variably from GI tract. Peak:
60 min PO; 2060 min PR; 5090 min SC; 3060 min IM; 20 min IV
Up to 7 h. Distribution:
Crosses bloodbrain barrier and placenta; distributed in breast milk. Metabolism:
In liver. Elimination:
90% in urine in 24 h; 710% in bile.
Assessment & Drug Effects
- Obtain baseline respiratory rate, depth, and rhythm and size of pupils before administering the drug. Respirations of 12/min
or below and miosis are signs of toxicity. Withhold drug and report to physician.
- Observe patient closely to be certain pain relief is achieved. Record relief of pain and duration of analgesia.
- Be alert to elevated pulse or respiratory rate, restlessness, anorexia, or drawn facial expression that may indicate need
- Differentiate among restlessness as a sign of pain and the need for medication, restlessness associated with hypoxia, and
restlessness caused by morphine-induced CNS stimulation (a paradoxic reaction that is particularly common in women and older
- Monitor for respiratory depression; it can be severe for as long as 24 h after epidural or intrathecal administration.
- Monitor carefully those at risk for severe respiratory depression after epidural or intrathecal injection: Older adult or
debilitated patients or those with decreased respiratory reserve (e.g., emphysema, severe obesity, kyphoscoliosis).
- Continue monitoring for respiratory depression for at least 24 h after each epidural or intrathecal dose.
- Assess vital signs at regular intervals. Morphine-induced respiratory depression may occur even with small doses, and it
increases progressively with higher doses (generally max: 90 min after SC, 30 min after IM, and 7 min after IV).
- Encourage changes in position, deep breathing, and coughing (unless contraindicated) at regularly scheduled intervals. Narcotic
analgesics also depress cough and sigh reflexes and thus may induce atelectasis, especially in postoperative patients.
- Be alert for nausea and orthostatic hypotension (with light-headedness and dizziness) in ambulatory patients or when a supine
patient assumes the head-up position or in patients not experiencing severe pain.
- Monitor I&O ratio and pattern. Report oliguria or urinary retention. Morphine may dull perception of bladder stimuli; therefore,
encourage the patient to void at least q4h. Palpate lower abdomen to detect bladder distention.
Patient & Family Education
- Avoid alcohol and other CNS depressants while receiving morphine.
- Do not use of any OTC drug unless approved by physician.
- Do not smoke or ambulate without assistance after receiving drug. Bedside rails are advised.
- Use caution or avoid tasks requiring alertness (e.g., driving a car) until response to drug is known since morphine may
cause drowsiness, dizziness, or blurred vision.