Morphine

Brand names: AVINZA, Arymo, Brillia Health Cough Control, EMBEDA, KADIAN, Kadian, Kadian ER, MORPHINE SULFATE, MS CONTIN, MS Contin, MorphaBond, Morphine Sulfate, Morphine Sulfate Extended Release, Morphine Sulfate Extended-Release, Morphine SulfateER, Morphine sulfate, morphine sulfate, Opium, Opium Tincture Deodorized

Warnings

BOXED WARNING (multiple black-box risks typical of Schedule II opioids): "Addiction, Abuse, and Misuse" - morphine "exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death," requiring assessment of each patient's risk before prescribing and monitoring during use; "Life-Threatening Respiratory Depression" - serious, life-threatening, or fatal respiratory depression may occur, with risk greatest during initiation or dose increases; "Accidental Ingestion" can cause fatal overdose, especially in children; "Neonatal Opioid Withdrawal Syndrome" with prolonged use in pregnancy; and "Risks from Concomitant Use with Benzodiazepines or Other CNS Depressants," which can cause profound sedation, respiratory depression, coma, and death. It is a Schedule II controlled substance with high abuse potential. Contraindications include significant respiratory depression, acute or severe bronchial asthma in an unmonitored setting, known or suspected GI obstruction/paralytic ileus, and hypersensitivity.

Contraindications

CONTRAINDICATIONS This preparation is not recommended for use in children. It should not be used in diarrhea caused by poisoning until the toxic material is eliminated from the gastrointestinal tract.

Overdose

OVERDOSAGE Signs and Symptoms Symptoms of toxicity are those of morphine and alcohol, such as nausea, vomiting, miosis, cool and clammy skin, respiratory and CNS depression, bradycardia, hypotension, and skeletal muscle flaccidity. Noncardiogenic pulmonary edema may develop after opioid overdose and monitoring of heart filling pressure may be helpful. Ethanol has been demonstrated to cause hypoglycemia in children or adults with limited glycogen stores. In severe overdosage, apnea, circulatory collapse, cardiac arrest, and death may occur. Treatment To obtain up-to-date information about the treatment of overdose, a good resource is your certified Regional Poison Control Center. Telephone numbers of certified poison control centers are listed in the Physicians' Desk Reference (PDR) . In managing overdosage, consider the possibility of multiple drug overdoses, interaction among drugs, and unusual drug kinetics in your patient. Initial management of opioid overdose should emphasize establishment of a secure airway and support of ventilation and perfusion. Meticulously monitor and maintain, within acceptable limits, the patient's vital signs, blood gases, serum electrolytes, blood glucose, etc. Naloxone antagonizes most effects of opioids. Protect the airway as naloxone may induce vomiting. Since naloxone has a shorter duration of action than opioids, repeated doses may be needed. In patients who abuse opioids chronically, a withdrawal syndrome may be manifest on administration of naloxone. This may include yawning, tearing, restlessness, sweating, dilated pupils, piloerection, vomiting, diarrhea, and abdominal cramps. This syndrome usually abates quickly as the effect of naloxone dissipates. Absorption of drugs from the gastrointestinal tract may be decreased by giving activated charcoal, which, in many cases, is more effective than emesis or lavage; consider charcoal instead of or in addition to gastric emptying. Repeated doses of charcoal over time may hasten elimination of some drugs that have been absorbed. Since opium tincture can delay gastric emptying, evacuation of the stomach may be beneficial. Safeguard the patient's airway when employing gastric emptying or charcoal. Monitor for and treat hypoglycemia. The use of forced diuresis, peritoneal dialysis, hemodialysis, or charcoal hemoperfusion has not been established to be beneficial.

Drug interactions

Drug Interactions When preparations containing opium are administered in combination with other drugs, the cautions applicable to each ingredient should be borne in mind. Reduced dosage is indicated in poor-risk patients, in the very young or very old patient, and in those who are receiving other central-nervous system depressants.

Uses

Morphine Sulfate Tablets are indicated for "the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate," covering relief of moderate to severe acute and chronic pain.

Dosage forms & strengths

C42917 Capsule Capsule, Extended Release Tablet Tablet, Extended Release Tablet, Film Coated, Extended Release TINCTURE

LAPINE MORPHINE IMMUNE GLOBULIN 12 [hp_C] LAPINE BRADYKININ IMMUNE GLOBULIN 12 [hp_C] LAPINE HISTAMINE IMMUNE GLOBULIN 12 [hp_C] MORPHINE SULFATE 10 mg MORPHINE SULFATE 100 mg NALTREXONE HYDROCHLORIDE 4 mg MORPHINE SULFATE 120 mg MORPHINE SULFATE 130 mg MORPHINE SULFATE 15 mg MORPHINE SULFATE 150 mg MORPHINE SULFATE 20 mg NALTREXONE HYDROCHLORIDE .8 mg NALTREXONE HYDROCHLORIDE 0.8 mg MORPHINE SULFATE 200 mg MORPHINE SULFATE 30 mg NALTREXONE HYDROCHLORIDE 1.2 mg MORPHINE SULFATE 40 mg MORPHINE SULFATE 45 mg MORPHINE SULFATE 50 mg NALTREXONE HYDROCHLORIDE 2 mg MORPHINE SULFATE 60 mg NALTREXONE HYDROCHLORIDE 2.4 mg MORPHINE SULFATE 70 mg MORPHINE SULFATE 75 mg MORPHINE SULFATE 80 mg NALTREXONE HYDROCHLORIDE 3.2 mg MORPHINE SULFATE 90 mg Morphine Sulfate 10 mg Morphine Sulfate 100 mg Morphine Sulfate 15 mg Morphine Sulfate 20 mg Morphine Sulfate 30 mg Morphine Sulfate 50 mg Morphine Sulfate 60 mg Morphine Sulfate 80 mg morphine sulfate 100 mg morphine sulfate 15 mg morphine sulfate 200 mg morphine sulfate 30 mg morphine sulfate 60 mg MORPHINE 1 g/100mL MORPHINE 10 mg/mL

DOSAGE AND ADMINISTRATION Usual Adult Dose – 0.6 mL orally 4 times a day.