II. Dosing: Analgesia
- Child
- IV/IM/SQ Morphine
- Dose: 0.1-0.2 mg/kg (0.025 mg/kg may be effective) up to 15 mg IV every 2 to 4 hours
- Oral Morphine Immediate Release (MSIR) PO or PR
- Dose: 0.2 to 0.5 mg/kg/dose up to 7.5 to 15 mg orally every 4 to 6 hours
- Oral Morphine Controlled Release
- Dose 0.3 to 0.6 mg/kg/dose orally every 12 hours
- IV/IM/SQ Morphine
- Adult
- IV Morphine
- Start: 0.1 to 0.2 mg/kg up to 15 mg IV
- Typical dose 4 mg (2 mg in the elderly) IV titrating every 15 minutes as needed
- IM/SC Morphine
- Give 10 mg IM/SC every 4 hours as needed
- Oral Morphine Immediate Release (MSIR) PO or PR
- Start at 7.5 to 15 mg orally every 4 hours
- May titrate up to 30 mg orally every 4 hours
- Morphine immediate release is available in 15 mg and 30 mg tablets
- Morphine immediate release 15 mg orally is equivalent to 5 mg IV
- Morphine is less euphoric than Oxycodone and Hydrocodone
- Oral Morphine Controlled Release
- MS Contin (or Oramorph SR) 30 mg orally every 8 to 12 hours
- Kadian 20 mg orally every 12 to 24 hours
- Avinza XR 30 mg orally daily
- IV Morphine
III. Dosing: Procedural Sedation and Analgesia
- 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)
- Intramuscular onset of activity may be delayed as long as 30 minutes
IV. Pharmacokinetics
- Onset 1 to 2 minutes
- Peaks 3 to 5 minutes
- Duration 1 to 2 hours
- Poor oral absorption
- Metabolized via conjugation with glucuronic acid
V. Metabolism
- Avoid in severe liver disease or Cirrhosis (increased Bioavailability and decreased clearance)
- Avoid in Renal Failure (accumulation of renally cleared metabolites)
VI. Advantages
- Compared with other Hydromorphone or Oxycodone, Morphine has less stimulation of euphoria (less abuse risk)
VII. Safety
- Pregnancy Category C
- Safe in Lactation
VIII. Adverse Effects
- See Opioid Adverse Effect
- Adverse effects (Pruritus, Nausea, Hypotension) occur in 10% of patients given IV Morphine
-
Histamine release (more than with other Opioid Analgesics)
- Pruritus and/or rash are common
- Typically not Allergic Reaction
-
Nausea or Vomiting
- Consider pretreatment with Antiemetic (e.g. Ondansetron)
-
Hypotension
- Consider pretreatment bolus of crystalloid (500 cc or 10-20 cc/kg NS)
- Oversedation
- Reversal: Naloxone
IX. Resources
- Morphine Sulfate (DailyMed)
- Morphine Sulfate Extended Release Tablet (DailyMed)
- Morphine Injection (DailyMed)
X. References
- Acker, Koval and Leeper (2017) Crit Dec Emerg Med 31(4): 3-13
- Velasco and Kiel (2023) Crit Dec Emerg Med 37(1): 4-9
Images: Related links to external sites (from Bing)
Related Studies
| morphine sulfate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MORPHINE SULFATE ER 10 MG CAP | Generic | $2.38 each |
| MORPHINE SULFATE ER 20 MG CAP | Generic | $3.29 each |
| MORPHINE SULFATE ER 30 MG CAP | Generic | $2.90 each |
| MORPHINE SULFATE IR 15 MG TAB | Generic | $0.24 each |
| MORPHINE SULFATE IR 30 MG TAB | Generic | $0.32 each |
| morphine (on 10/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MORPHINE SULF 10 MG/5 ML SOLN | Generic | $0.09 per ml |
| MORPHINE SULF 100 MG/5 ML CONC | Generic | $0.43 per ml |
| MORPHINE SULF ER 100 MG TABLET | Generic | $0.81 each |
| MORPHINE SULF ER 15 MG TABLET | Generic | $0.20 each |
| MORPHINE SULF ER 30 MG TABLET | Generic | $0.31 each |
| MORPHINE SULF ER 60 MG TABLET | Generic | $0.54 each |
Ontology: Morphine (C0026549)
| Definition (CHV) | a kind of narcotic pain relieving drug |
| Definition (NCI) | An opiate alkaloid isolated from the plant Papaver somniferum and produced synthetically. Morphine binds to and activates specific opiate receptors (delta, mu and kappa), each of which are involved in controlling different brain functions. In the central nervous and gastrointestinal systems, this agent exhibits widespread effects including analgesia, anxiolysis, euphoria, sedation, respiratory depression, and gastrointestinal system smooth muscle contraction. (NCI04) |
| Definition (MSH) | The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. |
| Definition (CSP) | principal and most active narcotic alkaloid of opium, having powerful analgesic action and some central stimulant action; abuse leads to dependence. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009020 |
| SnomedCT | 373529000, 73572009 |
| LNC | LP15174-3, MTHU004293 |
| English | Morphia, Morphinan-3,6-diol, 7,8-didehydro-4,5-epoxy-17-methyl- (5alpha,6alpha)-, Morphine [Chemical/Ingredient], morphines, morphine product, MORPHINE, morphine, Morphine (product), Morphine (substance), MORPH, Morphine |
| Swedish | Morfin |
| Czech | morfin |
| Finnish | Morfiini |
| Russian | MORFIN, MORFINA SUL'FAT, МОРФИН, МОРФИНА СУЛЬФАТ |
| Japanese | モルフィン, 硫酸モルヒネ, 塩酸モルヒネ, モルヒネ |
| Polish | Morfina |
| Spanish | morfina (producto), morfina (sustancia), morfina, Morfina |
| French | Morphine |
| German | Morphin, Morphium |
| Italian | Morfina |
| Portuguese | Morfina |
Ontology: Morphine Sulfate (C0066814)
| Definition (CHV) | a kind of narcotic pain relieving drug |
| Definition (CHV) | a kind of narcotic pain relieving drug |
| Definition (NCI) | The sulfate salt of morphine, an opiate alkaloid isolated from the plant Papaver somniferum and produced synthetically. Morphine binds to and activates specific opiate receptors (delta, mu and kappa), each of which are involved in controlling different brain functions. In the central nervous and gastrointestinal systems, this agent has widespread effects including analgesia, anxiolysis, euphoria, sedation, respiratory depression, and gastrointestinal system smooth muscle contraction. |
| Definition (NCI_NCI-GLOSS) | A drug used to treat moderate to severe pain. It binds to opioid receptors in the central nervous system and some other tissues. Morphine sulfate is made from opium. It is a type of opiate and a type of analgesic agent. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009020 |
| SnomedCT | 397240002, 60886004 |
| English | Morphine Sulfate, Sulfate, Morphine, morphine sulfate, narcotics morphine sulfate, morphine sulfate (medication), MORPHINE SULFATE, Morphine Sulfate [Chemical/Ingredient], morphine sulphate, Morphine sulfate (product), Morphine sulfate, Morphine sulfate (substance), Morphine sulphate |
| Portuguese | Sulfato de Morfina |
| Spanish | Sulfato de Morfina, sulfato de morfina (producto), sulfato de morfina (sustancia), sulfato de morfina |
| German | Morphinium-Sulfat |
Ontology: Kadian (C0700655)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| English | Kadian, kadian |
Ontology: Oramorph SR (C0700785)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009020 |
| English | Oramorph SR |
Ontology: MS Contin (C0700786)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D009020 |
| English | Contin, MS, ms contin, contin ms, MS Contin |
Ontology: Roxanol (C0700788)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| English | Roxanol, roxanol |
Ontology: MSIR (C0700789)
| Definition (CHV) | brand name of morphine sulfate |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| English | MSIR, msir, MSir |
