MORPHINE

Therapeutic Action

Centrally acting opioid analgesic

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Indications

Severe pain, especially in surgery, trauma and neoplastic disease

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Contraindications 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 in the event of overdose: excessive sedation, respiratory depression, coma. Monitor patient closely for several hours after administration. Administer with caution to patients with respiratory impairment, head injury, raised intracranial pressure, uncontrolled epilepsy or urethroprostatic disorders. In older 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 rd of the 3  trimester and during breast-feeding. In these situations, administer with caution, for a short period, at the lowest effective dose, and monitor the child.

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Forms Strengths And Route

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

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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

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Duration

Change to oral treatment as soon as possible.

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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

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Storage

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