Loading…
MORPHINE SULFATE is a brand name for Morphine. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Morphine is used for the symptomatic relief of severe pain; relief of dyspnoea of left ventricular failure and pulmonary oedema of cardiogenic origin; pre-operative use in adults.
Verbatim from this product's MHRA label. Tap a section to expand.
Posology Adults The dosage should be based on the severity of the pain and the response and tolerance of the patient. The usual adult subcutaneous or intramuscular dose is 10 mg every 4 hours, if necessary, but may range from 5 mg to 20 mg.
5 mg to 15 mg not more than 4-hourly, where necessary, but dosage and dosing interval must be titrated against the patient's response and adjustments made until analgesia is achieved. Elderly Because of the depressant effect on respiration, caution is necessary when giving morphine to the elderly and reduced doses may be required.
Paediatric population Use in children is not recommended. Hepatic impairment A reduction in dosage should be considered in hepatic impairment. Renal impairment The dosage should be reduced in moderate to severe renal impairment. For concomitant illnesses/conditions where dose reduction may be appropriate, see section
8. Hyperalgesia Hyperalgesia that does not respond to a further dose increase of morphine may occur in particular in high doses. A morphine dose reduction or change in opioid may be required. Gastrointestinal disorders An unexplained increase in abdominal pain associated with disturbed intestinal motility, symptoms of constipation, bloating, abdominal distension and increased gastroesophageal reflux during treatment with morphine sulfate, may indicate the development of opioid-induced bowel dysfunction or narcotic bowel syndrome.
In such situations consider the use of alternative analgesics and a morphine detoxification. Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs Concomitant use of Morphine sulfate and sedative medicines such as benzodiazepines or related drugs may result in sedation, respiratory depression, coma and death.
Because of these risks, concomitant prescribing with these sedative medicines should be reserved for patients for whom alternative treatment options are not possible. If a decision is made to prescribe Morphine sulfate concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible.
The patients should be followed closely for signs and symptoms of respiratory depression and sedation. 5). 5). Palliative care In the control of pain in terminal illness, these conditions should not necessarily be a deterrent to use. Acute chest syndrome (ACS) in patients with sickle cell disease (SCD) Due to a possible association between ACS and morphine use in SCD patients treated with morphine during a vaso-occlusive crisis, close monitoring for ACS symptoms is warranted.
Adrenal insufficiency Opioid analgesics may cause reversible adrenal insufficiency requiring monitoring and glucocorticoid replacement therapy. g. nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, or low blood pressure.
4. Method of administration The injection may be given by the intravenous, intramuscular or subcutaneous route. The subcutaneous route is not suitable for oedematous patients. Treatment goals and discontinuation Before initiating treatment with Morphine sulfate, a treatment strategy including treatment duration and treatment goals, and a plan for end of the treatment, should be agreed together with the patient, in accordance with pain management guidelines.
During treatment, there should be frequent contact between the physician and the patient to evaluate the need for continued treatment, consider discontinuation and to adjust dosages if needed. When a patient no longer requires therapy with Morphine sulfate, it may be advisable to taper the dose gradually to prevent symptoms of withdrawal.
4). Duration of treatment Morphine sulfate should not be used longer than necessary. 1. - Acute respiratory depression - Obstructive airways disease - Concurrent treatment with monoamine oxidase inhibitors or within two weeks of their discontinuation of treatment with them - Cerebral oedema - Head injuries - Coma - Convulsive disorders - Raised intracranial pressure - Biliary colic - Acute alcoholism - Antibiotic induced pseudomembranous colitis - Ulcerative colitis because of the risk of toxic megacolon - Phaeochromocytoma - Paralytic ileus - Acute diarrhoea caused by poisoning or invasive pathogens.
4 Special warnings and precautions for use Morphine is a potent medicine but with considerable potential for harmful effect, including addiction. It should be used only if other drugs with fewer hazards are inadequate, and with the recognition that it may possibly mask significant manifestations of disease which should be identified for proper diagnosis and treatment.
Use with caution or reduced doses Morphine should be given in reduced doses or with caution to patients with asthma or a reduced respiratory reserve (including emphysema, chronic cor pulmonale, kyphoscoliosis, excessive obesity and sleep apnoea).
1. - Acute respiratory depression - Obstructive airways disease - Concurrent treatment with monoamine oxidase inhibitors or within two weeks of their discontinuation of treatment with them - Cerebral oedema - Head injuries - Coma - Convulsive disorders - Raised intracranial pressure - Biliary colic - Acute alcoholism - Antibiotic induced pseudomembranous colitis - Ulcerative colitis because of the risk of toxic megacolon - Phaeochromocytoma - Paralytic ileus - Acute diarrhoea caused by poisoning or invasive pathogens.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Morphine in United Kingdom.
Know a brand we are missing in United Kingdom? Suggest a brand →
Brand names are compiled from public regulatory records for active-ingredient mapping only. Drugvu is not affiliated with any manufacturer. This is not medical advice.
Decreased Sex Hormones and increased prolactin Long-term use of opioid analgesics may be associated with decreased sex hormone levels and increased prolactin. Symptoms include decreased libido, impotence or amenorrhea. Excipients This medicinal product contains less than 1 mmol sodium (23 mg) per ml of solution, that is to say essentially ‘sodium-free’.
5 Interaction with other medicinal products and other forms of interaction Alcohol: enhanced sedative and hypotensive effects.
Anti-arrhythmics:
There may be delayed absorption of mexiletine.
Antibacterials:
The opioid analgesic papaveretum has been shown to reduce plasma ciprofloxacin concentration. The manufacturer of ciprofloxacin advises that premedication with opioid analgesics be avoided.
Antidepressants, anxiolytics, hypnotics:
Severe CNS excitation or depression (hypertension or hypotension) has been reported with the concurrent use of pethidine and monoamine oxidase inhibitors (MAOIs) including selegiline, moclobemide and linezolid. As it is possible that a similar interaction may occur with other opioid analgesics, morphine should be used with caution and consideration given to a reduction in dosage in patients receiving MAOIs.
The sedative effects of morphine (opioid analgesics) are enhanced when used with depressants of the central nervous system such as gabapentin or pregabalin, hypnotics, anxiolytics, tricyclic antidepressants and sedating antihistamines.
Antipsychotics: possible enhanced sedative and hypotensive effect. Antidiarrhoeal and antiperistaltic agents (such as loperamide and kaolin): concurrent use may increase the risk of severe constipation. Antimuscarinics: agents such as atropine antagonise morphine-induced respiratory depression and can partially reverse biliary spasm but are additive to the gastrointestinal and urinary tract effects.
Consequently, severe constipation and urinary retention may occur during intensive antimuscarinicanalgesic therapy.
Metoclopramide and domperidone:
There may be antagonism of the gastrointestinal effects of metoclopramide and domperidone.
Sedative medicines such as benzodiazepines or related drugs:
The concomitant use of opioids with sedative medicines such as benzodiazepines or related drugs increases the risk of sedation, respiratory depression, coma and death because of additive CNS depressant effect. 4). Cimetidine: inhibits the metabolism of morphine.
Rifampicin:
Plasma concentrations of morphine may be reduced by rifampicin.
Ritonavir:
Although there are no pharmacokinetic data available for concomitant use of ritonavir with morphine, ritonavir induces the hepatic enzymes responsible for the glucuronidation of morphine, and may possibly decrease plasma concentrations of morphine.
Oral P2Y12 inhibitors:
A delayed and decreased exposure to oral P2Y12 inhibitor antiplatelet therapy has been observed in patients with acute coronary syndrome treated with morphine. This interaction may be related to reduced gastrointestinal motility and apply to other opioids.
4). In patients with acute coronary syndrome, in whom morphine cannot be withheld and fast P2Y12 inhibition is deemed crucial, the use of a parenteral P2Y12 inhibitor may be considered. 6 Fertility, pregnancy and lactation Pregnancy Since morphine rapidly crosses the placental barrier, it is not advised to administer morphine during pregnancy and labour.
It may reduce uterine […]
3). Opioid analgesics in general should be administered with caution or in reduced doses to patients with hypotension, hypothyroidism, adrenocortical insufficiency, impaired kidney or liver function, prostatic hypertrophy, urethral stricture, shock, inflammatory or obstructive bowel disorders, or convulsive disorders.
2). 2). Dosage should be reduced in elderly and debilitated patients. Plasma concentrations of morphine may be reduced by rifampicin. The analgesic effect of morphine should be monitored and doses of morphine adjusted during and after treatment with rifampicin.
Sleep-related breathing disorders Opioids can cause sleep-related breathing disorders including central sleep apnoea (CSA) and sleep-related hypoxemia. Opioid use increases the risk of CSA in a dose- dependent fashion. In patients who present with CSA, consider decreasing the total opioid dosage.
Severe cutaneous adverse reactions (SCARs) Acute generalized exanthematous pustulosis (AGEP), which can be life-threatening or fatal, has been reported in association with morphine treatment. Most of these reactions occurred within the first 10 days of treatment.
Patients should be informed about the signs and symptoms of AGEP and advised to seek medical care if they experience such symptoms. If signs and symptoms suggestive of these skin reactions appear, morphine should be withdrawn and an alternative treatment considered.
Hepatobiliary disorders Opioids such as morphine should either be avoided in patients with biliary disorders or they should be given with an antispasmodic. Morphine may cause dysfunction and spasm of the sphincter of Oddi, thus raising intrabiliary pressure and increasing the risk of biliary tract symptoms and pancreatitis.
3). In patients given morphine after cholecystectomy, biliary pain has been induced. Opioid Use Disorder (abuse and dependence) Tolerance and physical and/or psychological dependence may develop upon repeated administration of opioids such Morphine sulfate.
Repeated use of Morphine sulfate can lead to Opioid Use Disorder (OUD). A higher dose and longer duration of opioid treatment, can increase the risk of developing OUD. Abuse or intentional misuse of Morphine sulfate may result in overdose and/or death.
g. major depression, anxiety and personality disorders). 2). Before and during treatment the patient should also be informed about the risks and signs of OUD. If these signs occur, patients should be advised to contact their physician.
g. too early requests for refills). This includes the review of concomitant opioids and psycho- active drugs (like benzodiazepines). For patients with signs and symptoms of OUD, consultation with an addiction specialist should be considered.
[…]