Therapeutic Action
Centrally acting opioid analgesic
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Drug reference
Centrally acting opioid analgesic
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Severe and persistent pain, especially cancer pain
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Do not administer to patients with severe respiratory impairment or decompensated hepatic impairment. Do not initiate treatment with the sustained-release formulation in elderly patients or those with renal or hepatic impairment. Begin treatment with the immediate release formulation (MIR). 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. 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.), neuroleptics (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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10 mg, 30 mg and 60 mg sustained-release capsules or tablets
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Usually, the effective daily dose is determined during the initial treatment with immediate-release morphine (MIR). When changing from MIR to MSR, the daily dose remains the same. For example, if the effective dose of MIR is 20 mg every 4 hours (120 mg daily), the dose of MSR is 60 mg every 12 hours (120 mg daily). If treatment is initiated directly with MSR: Child over 6 months: initially 0.5 mg/kg every 12 hours Adult: initially 30 mg every 12 hours Adjust the dose if necessary, increasing the dose by 50% per day until pain relief is obtained. Patients stabilized on MSR may require rescue doses of MIR in the event of episodic (breakthrough) pain. A rescue dose corresponds to 10% of the daily MSR dose. If a patient regularly requires more than 3 rescue doses per day, increase the daily MSR dose by the sum of rescue doses.
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According to clinical response. Do not stop long-term treatment abruptly. Decrease doses progressively to avoid withdrawal symptoms.
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Administer an appropriate laxative (e.g. lactulose) if analgesic treatment continues more than 48 hours. Do not crush or chew capsules. They can be opened and emptied into food. Morphine is on the list of narcotics: follow national regulations.
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– – Below 25 °C
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initially 0.5 mg/kg every 12 hours
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