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
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| 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 |