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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 Sulfate Solution for Injection is indicated for the relief of moderate to severe pain. Morphine is used especially in pain associated with cancer, myocardial infarction and surgery. Morphine also helps to relieve the anxiety and insomnia which may be associated with severe pain.
Verbatim from this product's MHRA label. Tap a section to expand.
4).
Adults and children over 12 years:
Morphine Sulfate Solution for Injection is formulated for use by the intravenous route in Patient Controlled Analgesia (PCA) systems. PCA, which permits adjustment of dosage according to the patient’s individual needs, must only be carried out in departments and by staff who are trained and have experience of the system.
Patient selection for the use of PCA must ensure that the patient is capable of understanding and following the instructions of the medical/nursing staff. The specific department or unit protocols must be covered to ensure aseptic transfer of the contents of the ampoule or vial to the PCA system.
There is a considerable variation in analgesic requirements among patients and therefore individualised treatment strategies are required. Dosage should be based on the severity of the pain and the response and opiate tolerance of the patient.
Loading Dose Loading doses of typically between 1mg and 10mg (maximum 15mg) of Morphine Sulfate Solution for Injection may be given by intravenous infusion over four or five minutes. The loading dose used will depend upon the patient’s diagnosis and condition.
PCA demand dose An initial demand dose of 1mg Morphine Sulfate Solution for Injection with a lockout period of 5 to 10 minutes is recommended. Dosages may vary depending on the loading dose, the tolerance and condition of the patient, and whether a background infusion of morphine sulfate is being given.
The patient should be specifically monitored for pain, sedation and respiratory rate during the first few hours of treatment to ensure that the dosage regimen is suitable. The duration of treatment should be kept to a minimum, although dependence and tolerance are not generally a problem when morphine is used legitimately in patients with opioid-sensitive pain.
Use in children:
Not recommended for children under 12 years.
Use in the elderly:
Morphine doses need to be reduced in elderly patients. Discontinuation of therapy An abstinence syndrome may be precipitated if opioid administration is suddenly discontinued. Therefore the dose should be gradually reduced prior to discontinuation.
The side-effects most commonly seen with morphine and other opioids are respiratory depression, nausea, vomiting, constipation, drowsiness and confusion. With long term use these symptoms generally lessen, although constipation frequently persists.
The following adverse effects are from published literature and frequencies are not known. 4), restlessness, mood changes, hallucinations, delirium, disorientation, excitation, agitation, sleep disturbance. 4). Endocrine Long term use of opioid analgesics can cause adrenal insufficiency.
Exacerbation of pancreatitis. Eye disorders Visual disturbances, nystagmus, miosis. Ear and Labyrinth disorders Vertigo. Cardiac disorders Bradycardia, tachycardia, palpitations, hypotension, hypertension, syncope. Vascular disorders Orthostatic hypotension, facial flushing, oedema.
Gastrointestinal disorders Dry mouth, dyspepsia, paralytic ileus, abdominal pain, anorexia. Hepatobiliary disorders Biliary spasm. Immune system disorders Anaphylactoid reactions. Anaphylactic reactions to morphine have been reported rarely.
Musculoskeletal, connective tissue and bone disorder Muscle fasciculation, myoclonus, rhabdomyolysis, muscle rigidity. Renal and urinary disorders Difficult micturition, ureteric spasm, urinary retention. Reproduction and sexual disorders Long term use of opioid analgesics can cause hypogonadism in both men and women.
This can lead to amenorrhoea, reduced libido, infertility, depression and erectile dysfunction. Respiratory disorders Bronchospasm (in association with anaphylaxis), inhibition of cough reflex. Skin and subcutaneous tissue disorders Rashes, urticaria, pruritus.
General disorders and administration site conditions. Sweating, hypothermia, malaise, asthenia, pain and irritation at the injection site, drug withdrawal syndrome. Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important.
Drug dependence, tolerance and potential for abuse For all patients, prolonged use of this product may lead to drug dependence (addiction), even at therapeutic doses. , major depression). Additional support and monitoring may be necessary when prescribing for patients at risk of opioid misuse.
A comprehensive patient history should be taken to document concomitant medications, including over-the-counter medicines and medicines obtained on-line, and past and present medical and psychiatric conditions. Patients may find that treatment is less effective with chronic use and express a need to increase the dose to obtain the same level of pain control as initially experienced.
Patients may also supplement their treatment with additional pain relievers. These could be signs that the patient is developing tolerance. The risks of developing tolerance should be explained to the patient. Overuse or misuse may result in overdose and/or death.
It is important that patients only use medicines that are prescribed for them at the dose they have been prescribed and do not give this medicine to anyone else. Patients should be closely monitored for signs of misuse, abuse, or addiction.
The clinical need for analgesic treatment should be reviewed regularly. Drug withdrawal syndrome Prior to starting treatment with any opioids, a discussion should be held with patients to put in place a withdrawal strategy for ending treatment with morphine sulfate.
Drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to minimise symptoms of withdrawal. Tapering from a high dose may take weeks to months.
The opioid drug withdrawal syndrome is characterised by some or all of the following: restlessness, lacrimation, rhinorrhoea, yawning, perspiration, chills, myalgia, mydriasis and palpitations. Other symptoms may also develop including irritability, agitation, anxiety, hyperkinesia, tremor, weakness, insomnia, anorexia, abdominal cramps, nausea, vomiting, diarrhoea, increased blood pressure, increased respiratory rate or heart rate.
Morphine Sulfate Solution for Injection should not be given to patients with known hypersensitivity to morphine or other opioid preparations. Use of Morphine Sulfate Solution for Injection is also contraindicated in patients with respiratory depression; obstructive airways disease; excessive bronchial secretions; during a bronchial asthma attack or in heart failure secondary to chronic lung disease; head injury; raised intra-cranial pressure; coma; convulsion disorders; ulcerative colitis; in presence of a risk of paralytic ileus; biliary and renal tract spasm and acute alcoholism; phaeochromocytoma.
Morphine Sulfate Solution for Injection should not be given to patients with moderate to severe renal impairment (glomerular filtration rate <20mL/min) or with severe or acute liver failure. Morphine Sulfate Solution for Injection is contraindicated in patients receiving monoamine oxidase inhibitors or within two weeks of discontinuing such treatment.
Use of Morphine Sulfate Solution for Injection during pregnancy or lactation is not recommended.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Morphine in United Kingdom.
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If women take this drug during pregnancy, there is a risk that their newborn infants will experience neonatal withdrawal syndrome. Hyperalgesia Hyperalgesia may be diagnosed if the patient on long-term opioid therapy presents with increased pain.
This might be qualitatively and anatomically distinct from pain related to disease progression or to breakthrough pain resulting from development of opioid tolerance. Pain associated with hyperalgesia tends to be more diffuse than the pre-existing pain and less defined in quality.
Symptoms of hyperalgesia may resolve with a reduction of opioid dose. As with other narcotics, a dose reduction may be appropriate in elderly patients, in patients with hypothyroidism, renal and chronic hepatic disease. Morphine Sulfate Solution for Injection should be used with caution in debilitated patients and those with Acute chest syndrome (ACS) in patients with sickle cell disease (SCD); adrenal insufficiency; hypopituitarism; prostatic hypertrophy; shock; diabetes mellitus; diseases of the biliary tract; myasthenia gravis; cardiac arrhythmias; excessive obesity; hypotension and severe cardiac failure.
It should also be used with caution post-operatively following total joint arthroplasty (colonic pseudo- obstruction). 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.
Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs: Concomitant use of Morphine Sulfate 1mg in 1mL Solution for Injection 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 1mg in 1mL Solution for Injection 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). 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.
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. 5). 2 % of the WHO recommended maximum daily intake of 2g sodium for an adult.