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morphine sulfate

(mor' feen)
Brand names: Kadian, MS Contin

Drug class
Opioid agonist analgesic

Indications
• Relief of moderate to severe acute and chronic pain
• Preoperative medication to sedate and allay apprehension, facilitate induction of
anesthesia, and reduce anesthetic dosage
• Analgesic adjunct during anesthesia
• Component of most preparations that are referred to as Brompton's cocktail or
mixture, an oral alcoholic solution that is used for chronic severe pain, especially in
terminal cancer patients
• Intraspinal use with microinfusion devices for the relief of intractable pain
• Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary
edema

Contraindications and cautions


• Contraindicated with hypersensitivity to opioids; diarrhea caused by poisoning until
toxins are eliminated; during labor or delivery of a premature infant (may cross
immature blood–brain barrier more readily); after biliary tract surgery or following
surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may
prolong labor).
• Use cautiously with head injury and increased intracranial pressure; acute asthma,
COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may
decrease respiratory drive and increase airway resistance); lactation (wait 4–6 hr
after administration to nurse the baby); acute abdominal conditions, CV disease,
supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism,
delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis,
Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery,
toxic psychosis, renal or hepatic dysfunction.

Available forms
Injection—0.5, 1, 2, 4, 5, 8, 10, 15, 25, 50 mg/mL; tablets—15, 30 mg; CR tablets—15, 60, 100,
200 mg; ER tablets—30, 60, 100 mg; soluble tablets—10, 15, 30 mg; oral solution—10, 20,
100 mg/5 mL; concentrated oral solution—20 mg/mL, 100 mg/5 mL; suppositories—5, 10, 20,
30 mg; capsules—15, 30 mg; SR capsules—20, 30, 50, 60, 100 mg

Dosages
ADULTS
Oral
One-third to one-sixth as effective as parenteral administration because of first-pass metabolism;
10–30 mg q 4 hr PO. Controlled-release: 30 mg q 8–12 hr PO or as directed by physician;
Kadian: 20–100 mg PO daily–24-hr release system; MS Contin: 200 mg PO q 12 hr.
IV
2.5–15 mg/70 kg of body weight in 4–5 mL water for injection administered over 4–5 min, or as
directed by physician. Continuous IV infusion: 0.1–1 mg/mL in 5% dextrose in water by controlled
infusion device.
Epidural
Initial injection of 5 mg in the lumbar region may provide pain relief for up to 24 hr. If adequate
pain relief is not achieved within 1 hr, incremental doses of 1–2 mg may be given at intervals
sufficient to assess effectiveness, up to 10 mg/24 hr. For continuous infusion, initial dose of 2–4
mg/24 hr is recommended. Further doses of 1–2 mg may be given if pain relief is not achieved
initially.
PEDIATRIC PATIENTS
Do not use in premature infants.
SC or IM
0.05–0.2 mg/kg (up to 15 mg per dose) q 4 hr or as directed by physician.
GERIATRIC PATIENTS OR IMPAIRED ADULTS
Use caution. Respiratory depression may occur in the elderly, the very ill, those with respiratory
problems. Reduced dosage may be necessary.
Epidural
Use extreme caution; injection of < 5 mg in the lumbar region may provide adequate pain relief
for up to 24 hr.

Adverse effects
• CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium,
insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy,
impaired mental and physical performance, coma, mood changes, weakness,
headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex
• CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia,
arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic
hypotension, syncope
• Dermatologic: Pruritus, urticaria, laryngospasm, bronchospasm, edema
• GI: Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm;
increased colonic motility in patients with chronic ulcerative colitis
• GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy,
oliguria, antidiuretic effect, reduced libido or potency
• Local: Tissue irritation and induration (SC injection)
• Major hazards: Respiratory depression, apnea, circulatory depression,
respiratory arrest, shock, cardiac arrest
• Other: Sweating, physical tolerance and dependence, psychological dependence
Interactions
Drug-drug
• Increased likelihood of respiratory depression, hypotension, profound sedation or
coma in patients receiving barbiturate general anesthetics

Interventions
• Caution patient not to chew or crush controlled-release preparations.
• Dilute and administer slowly IV to minimize likelihood of adverse effects.
• Tell patient to lie down during IV administration.
• Keep opioid antagonist and facilities for assisted or controlled respiration readily
available during IV administration.
• Use caution when injecting SC or IM into chilled areas or in patients with hypotension
or in shock; impaired perfusion may delay absorption; with repeated doses, an
excessive amount may be absorbed when circulation is restored.
• Reassure patients that they are unlikely to become addicted; most patients who
receive opioids for medical reasons do not develop dependence syndromes.

• Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives,


tranquilizers, over-the-counter drugs.
• Swallow controlled-release preparation (MS Contin, Oramorph SR) whole; do not cut,
crush, or chew them.
• Do not take leftover medication for other disorders, and do not let anyone else take
your prescription.
• These side effects may occur: Nausea, loss of appetite (take with food, lie quietly);
constipation (use laxative); dizziness, sedation, drowsiness, impaired visual acuity
(avoid driving or performing tasks that require alertness and visual acuity).
• Report severe nausea, vomiting, constipation, shortness of breath or difficulty
breathing, rash.