Analgesic

Morphine Sulfate

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Morphine Sulfate, Morphine, MS Contin, Oramorph SR, MSIR, Roxanol, Kadian, Avinza

  • See Also
  1. Opioid
  2. Bowel Regimen in Chronic Narcotic Use
  3. Narcotic Overdose
  • Dosing
  • Analgesia
  1. Child
    1. IV/IM/SQ Morphine
      1. Dose: 0.1-0.2 mg/kg (0.025 mg/kg may be effective) up to 15 mg IV every 2 to 4 hours
    2. Oral Morphine Immediate Release (MSIR) PO or PR
      1. Dose: 0.2 to 0.5 mg/kg/dose up to 7.5 to 15 mg orally every 4 to 6 hours
    3. Oral Morphine Controlled Release
      1. Dose 0.3 to 0.6 mg/kg/dose orally every 12 hours
  2. Adult
    1. IV Morphine
      1. Start: 0.1 to 0.2 mg/kg up to 15 mg IV
      2. Typical dose 4 mg (2 mg in the elderly) IV titrating every 15 minutes as needed
    2. IM/SC Morphine
      1. Give 10 mg IM/SC every 4 hours as needed
    3. Oral Morphine Immediate Release (MSIR) PO or PR
      1. Start at 7.5 to 15 mg orally every 4 hours
      2. May titrate up to 30 mg orally every 4 hours
      3. Morphine immediate release is available in 15 mg and 30 mg tablets
      4. Morphine immediate release 15 mg orally is equivalent to 5 mg IV
      5. Morphine is less euphoric than Oxycodone and Hydrocodone
    4. Oral Morphine Controlled Release
      1. MS Contin (or Oramorph SR) 30 mg orally every 8 to 12 hours
      2. Kadian 20 mg orally every 12 to 24 hours
      3. Avinza XR 30 mg orally daily
  1. IV/IM/SC: 0.05 to 0.2 mg/kg every 2-4 hours up to 15 mg (typically given in 2-4 mg increments)
  2. Intramuscular onset of activity may be delayed as long as 30 minutes
  • Pharmacokinetics
  1. Onset 1 to 2 minutes
  2. Peaks 3 to 5 minutes
  3. Duration 1 to 2 hours
  4. Poor oral absorption
  5. Metabolized via conjugation with glucuronic acid
  • Metabolism
  1. Avoid in severe liver disease or Cirrhosis (increased Bioavailability and decreased clearance)
  2. Avoid in Renal Failure (accumulation of renally cleared metabolites)
  • Advantages
  1. Compared with other Hydromorphone or Oxycodone, Morphine has less stimulation of euphoria (less abuse risk)
  • Safety
  1. Pregnancy Category C
  2. Safe in Lactation
  • Adverse Effects
  1. See Opioid Adverse Effect
  2. Adverse effects (Pruritus, Nausea, Hypotension) occur in 10% of patients given IV Morphine
  3. Histamine release (more than with other Opioid Analgesics)
    1. Pruritus and/or rash are common
    2. Typically not Allergic Reaction
  4. Nausea or Vomiting
    1. Consider pretreatment with Antiemetic (e.g. Ondansetron)
  5. Hypotension
    1. Consider pretreatment bolus of crystalloid (500 cc or 10-20 cc/kg NS)
  6. Oversedation
    1. Reversal: Naloxone
  • Resources
  1. Morphine Sulfate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3f3a870e-f325-475b-8453-fe3d1bb8f54a
  2. Morphine Sulfate Extended Release Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e044604d-f210-4411-a6e8-6a9dbdb1a9bd
  3. Morphine Injection (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1d181906-f3ec-4222-1883-e61577a3122e
  • References
  1. Acker, Koval and Leeper (2017) Crit Dec Emerg Med 31(4): 3-13
  2. Velasco and Kiel (2023) Crit Dec Emerg Med 37(1): 4-9