MORPHINE injectable

Prescription under medical supervision

Therapeutic action

– Centrally acting opioid analgesic

Indications

– Severe pain, especially in surgery, trauma and neoplastic disease

Forms and strengths, route of administration

– 10 mg ampoule (10 mg/ml, 1 ml) for SC, IM or IV injection

Dosage

– SC and IM route
Child over 6 months and adult: 0.1 to 0.2 mg/kg every 4 hours if necessary

 IV route
Child over 6 months and adult: 0.1 mg/kg administered in fractionated doses (0.05 mg/kg every 10 minutes) every 4 hours if necessary

Duration

– Change to oral treatment as soon as possible.

Contra-indications, adverse effects, precautions

– Do not administer to patients with severe respiratory impairment or decompensated hepatic impairment.
– May cause:
• dose-related sedation and respiratory depression, nausea, vomiting, constipation, urinary retention, confusion, raised intracranial pressure, pruritus;
• in the event of overdose: excessive sedation, respiratory depression, coma.
– Management of respiratory depression includes assisted ventilation and/or administration of naloxone. Monitor patient closely for several hours.
– Administer with caution to patients with respiratory impairment, head injury, raised intracranial pressure, uncontrolled epilepsy or urethroprostatic disorders.
– In elderly patients and in patients with severe renal or hepatic impairment: reduce doses by half and administer less frequently, according to clinical response (risk of accumulation).
– Do not combine with opioid analgesics with mixed agonist-antagonist activity such as buprenorphine, nalbuphine, pentazocine (competitive action).
– Increased risk of sedation and respiratory depression, when combined with alcohol and drugs acting on the central nervous system: benzodiazepines (diazepam, etc.), antipsychotics (chlorpromazine, haloperidol, etc.), antihistamines (chlorphenamine, promethazine), phenobarbital, etc.
– Pregnancy and breast-feeding: no contra-indication. The child may develop withdrawal symptoms, respiratory depression and drowsiness when the mother receives morphine at the end of the 3rd trimester and during breast-feeding. In these situations, administer with caution, for a short period, at the lowest effective dose, and monitor the child.

Remarks

– Administer an appropriate laxative (e.g. lactulose) if analgesic treatment continues more than 48 hours.
– Morphine is on the list of narcotics: follow national regulations.
– Storage: