Individual generic drug information

morphine

Reference monograph

Part of registered formulation

MORPHINE

Reference record: Morphine
Source: BNF 80 (2020–2021)
Printed source pages: 506, 507, 508
Age groups indexed: 3

Individual active ingredientSource records are displayed separately

Some source sections could not be separated reliably in the extraction. Review the printed source pages when a field is missing or incomplete.

Overview

Extracted information for Morphine only.

Indications And Dose

Pain ▶BY SUBCUTANEOUS INJECTION ▶Child 1–5 months: Initially 100–200 micrograms/kg every 6 hours, adjusted according to response ▶Child 6 months–1 year: Initially 100–200 micrograms/kg every 4 hours, adjusted according to response ▶Child 2–11 years: Initially 200 micrograms/kg every 4 hours, adjusted according to response ▶Child 12–17 years: Initially 2.5–10 mg every 4 hours, adjusted according to response ▶INITIALLY BY INTRAVENOUS INJECTION ▶Child 1–5 months: 100 micrograms/kg every 6 hours, adjusted according to response, dose to be administered over at least 5 minutes, alternatively (by intravenous injection) initially 100 micrograms/kg, dose to be administered over at least 5 minutes, followed by (by continuous intravenous infusion) 10–30 micrograms/kg/hour, adjusted according to response ▶Child 6 months–11 years: 100 micrograms/kg every 4 hours, adjusted according to response, dose to be administered over at least 5 minutes, alternatively (by intravenous injection) initially 100 micrograms/kg, dose to be administered over at least 5 minutes, followed by (by continuous intravenous infusion) 20–30 micrograms/kg/hour, adjusted according to response ▶Child 12–17 years: 5 mg every 4 hours, adjusted according to response, dose to be administered over at least 5 minutes, alternatively (by intravenous injection) initially 5 mg, dose to be administered over at least 5 minutes, followed by (by continuous intravenous infusion) 20–30 micrograms/kg/hour, adjusted according to response ▶BY MOUTH, OR BY RECTUM ▶Child 1–2 months: Initially 50–100 micrograms/kg every 4 hours, adjusted according to response ▶Child 3–5 months: 100–150 micrograms/kg every 4 hours, adjusted according to response ▶Child 6–11 months: 200 micrograms/kg every 4 hours, adjusted according to response ▶Child 1 year: Initially 200–300 micrograms/kg every 4 hours, adjusted according to response ▶Child 2–11 years: Initially 200–300 micrograms/kg every 4 hours (max. per dose 10 mg), adjusted according to response ▶Child 12–17 years: Initially 5–10 mg every 4 hours, adjusted according to response Acute pain ▶BY MOUTH, OR BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION ▶Adult: Initially 10 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration, use dose for elderly in frail patients ▶Elderly: Initially 5 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: Initially 5 mg every 4 hours, adjusted according to response, dose can be adjusted more frequently during titration, reduced dose recommended in frail and elderly patients Chronic pain ▶BY MOUTH, OR BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION ▶Adult: Initially 5–10 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients ▶BY RECTUM ▶Adult: Initially 15–30 mg every 4 hours, adjusted according to response Pain (with modified-release 12-hourly preparations) ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: Every 12 hours, dose adjusted according to daily morphine requirements, dosage requirements should be reviewed if the brand is altered Pain (with modified-release 24-hourly preparations) ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: Every 24 hours, dose adjusted according to daily morphine requirements, dosage requirements should be reviewed if the brand is altered Pain management in palliative care (starting dose for opioid-naïve patients) ▶BY MOUTH ▶Adult: 20–30 mg daily in divided doses, using immediate-release preparation 4-hourly or a 12-hourly modiﬁed-release preparation, for management of breakthrough pain and other general advice, see Pain management with opioids under Prescribing in palliative care p. 28. Pain management in palliative care (starting dose for patients being switched from a regular weak opioid) ▶BY MOUTH ▶Adult: 40–60 mg daily in divided doses, using immediate-release preparation 4-hourly or 12-hourly modiﬁed-release preparation, for management of breakthrough pain and other general advice, see Pain management with opioids under Prescribing in palliative care p. 28. Pain in palliative care (following initial titration) ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: Usual dose 30 mg every 4 hours; up to 200 mg every 4 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids under Prescribing in palliative care p. 28. ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: Usual dose 100 mg every 12 hours; up to 600 mg every 12 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids under Prescribing in palliative care p. 28. Cough in palliative care ▶BY MOUTH ▶Adult: Initially 5 mg every 4 hours Premedication ▶BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION ▶Adult: Up to 10 mg, dose to be administered 60–90 minutes before operation Patient controlled analgesia (PCA) ▶BY INTRAVENOUS INFUSION ▶Adult: (consult local protocol) Myocardial infarction ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 5–10 mg, followed by 5–10 mg if required, dose to be administered at a rate of 1–2 mg/minute, use dose for elderly in frail patients ▶Elderly: 2.5–5 mg, followed by 2.5–5 mg if required, dose to be administered at a rate of 1–2 mg/minute Acute pulmonary oedema ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 5–10 mg, dose to be administered at a rate of 2 mg/minute, use dose for elderly in frail patients ▶Elderly: 2.5–5 mg, dose to be administered at a rate of 2 mg/minute Dyspnoea at rest in palliative care ▶BY MOUTH ▶Adult: Initially 5 mg every 4 hours, to be given in carefully titrated doses DOSE EQUIVALENCE AND CONVERSION ▶The doses stated refer equally to morphine hydrochloride and sulfate. l UNLICENSED USE Oramorph ® solution and MXL ® capsules not licensed for use in children under 1 year. Sevredol ® tablets not licensed for use in children under 3 years. Oramorph ® unit dose vials and Filnarine ® SR tablets not licensed for use in children under 6 years. MST Continus ® preparations licensed to treat children with cancer pain (age-range not speciﬁed by manufacturer). ▶With rectal use in children Suppositories are not licensed for use in children.

Source pages 506, 507

Contra Indications

Acute abdomen. delayed gastric emptying. heart failure secondary to chronic lung disease. phaeochromocytoma

Source page 507

Cautions

Cardiac arrhythmias. pancreatitis. severe cor pulmonale

Source page 507

Prescribing And Dispensing Information

Modiﬁed- release preparations are available as 12-hourly or 24-hourly formulations; prescribers must ensure that the correct preparation is prescribed. Preparations that should be given 12-hourly include Filnarine ® SR, MST Continus ®, Morphgesic ® SR and Zomorph ®. Preparations that should be given 24-hourly include MXL ®. Prescriptions must specify the ‘form’. ▶With rectal use Both the strength of the suppositories and the morphine salt contained in them must be speciﬁed by the prescriber. Palliative care For further information on the use of morphine in palliative care, see www.medicinescomplete. com/#/content/palliative/morphine.

Source page 507

Exceptions To Legal Category

Morphine Oral Solutions Prescription-only medicines or schedule 2 controlled drug. The proportion of morphine hydrochloride may be altered when speciﬁed by the prescriber; if above 13 mg per 5 mL the solution becomes a schedule 2 controlled drug. It is usual to adjust the strength so that the dose volume is 5 or 10 mL. Oral solutions of morphine can be prescribed by writing the formula: Morphine hydrochloride 5 mg Chloroform water to 5 mL

Source pages 507, 508

Safety

Extracted information for Morphine only.

Important Safety Information

Do not confuse modiﬁed-release 12-hourly preparations with 24-hourly preparations, see Prescribing and dispensing information.

Source page 507

Interactions

→Appendix 1: opioids Nervous system

Source page 507

Side Effects

▶Common or very common ▶With oral use Appetite decreased. asthenic conditions. gastrointestinal discomfort. insomnia. neuromuscular dysfunction ▶Uncommon ▶With oral use Agitation. bronchospasm. ileus. mood altered. myoclonus. peripheral oedema. pulmonary oedema. seizure. sensation abnormal. syncope. taste altered ▶Frequency not known ▶With oral use Amenorrhoea. biliary pain. cough decreased. hyperalgesia. hypertension. pancreatitis exacerbated. sexual dysfunction. thinking abnormal. ureteral spasm ▶With parenteral use Alertness decreased. bile duct disorders . mood altered. myoclonus. sexual dysfunction. ureteral spasm. urinary disorders. vision disorders

Source page 507

Breast Feeding

Therapeutic doses unlikely to affect infant.

Source page 507

Hepatic Impairment

Manufacturer advises caution. Avoid oral preparations in acute impairment; for injectable preparations—consult product literature. Dose adjustments Manufacturer advises consider dose reduction—consult product literature.

Source page 507

Renal Impairment

Avoid use or reduce dose; opioid effects increased and prolonged; increased cerebral sensitivity.

Source page 507

Monitoring Requirements

Possible association between acute chest syndrome in patients with sickle cell disease treated with morphine during a vaso-occlusive crisis—manufacturer advises close monitoring for acute chest syndrome symptoms during treatment.

Source page 507

Dose and formulations

Extracted information for Morphine only.

Directions For Administration

▶With intravenous use in children For continuous intravenous infusion, dilute with Glucose 5% or 10% or Sodium Chloride 0.9%. ▶With oral use For modiﬁed release capsules—swallow whole or open capsule and sprinkle contents on soft food.

Source page 507

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral Nervous system solution, solution for injection, infusion, solution for infusion, suppository Modified-release tablet CAUTIONARY AND ADVISORY LABELS 2, 25 ▶MST Continus (Napp Pharmaceuticals Ltd) Morphine sulfate 5 mg MST Continus 5mg tablets | 60 tablet P £3.29 DT = £3.29 b Morphine sulfate 10 mg MST Continus 10mg tablets | 60 tablet P £5.20 DT = £5.20 b Morphine sulfate 15 mg MST Continus 15mg tablets | 60 tablet P £9.10 DT = £9.10 b Morphine sulfate 30 mg MST Continus 30mg tablets | 60 tablet P £12.47 DT = £12.47 b Morphine sulfate 60 mg MST Continus 60mg tablets | 60 tablet P £24.32 DT = £24.32 b Morphine sulfate 100 mg MST Continus 100mg tablets | 60 tablet P £38.50 DT = £38.50 b Morphine sulfate 200 mg MST Continus 200mg tablets | 60 tablet P £81.34 DT = £81.34 b ▶Morphgesic SR (Advanz Pharma) Morphine sulfate 10 mg Morphgesic SR 10mg tablets | 60 tablet P £3.85 DT = £5.20 b Morphine sulfate 30 mg Morphgesic SR 30mg tablets | 60 tablet P £9.24 DT = £12.47 b Morphine sulfate 60 mg Morphgesic SR 60mg tablets | 60 tablet P £18.04 DT = £24.32 b Morphine sulfate 100 mg Morphgesic SR 100mg tablets | 60 tablet P £28.54 DT = £38.50 b Tablet CAUTIONARY AND ADVISORY LABELS 2 ▶Sevredol (Napp Pharmaceuticals Ltd) Morphine sulfate 10 mg Sevredol 10mg tablets | 56 tablet P £5.31 DT = £5.31 b Morphine sulfate 20 mg Sevredol 20mg tablets | 56 tablet P £10.61 DT = £10.61 b Morphine sulfate 50 mg Sevredol 50mg tablets | 56 tablet P £28.02 DT = £28.02 b Solution for injection ▶Morphine (Non-proprietary) Morphine sulfate 1 mg per 1 ml Morphine sulfate 5mg/5ml solution for injection ampoules | 10 ampoule P £47.30 DT = £47.30 b Morphine sulfate 1mg/1ml solution for injection ampoules | 10 ampoule P £37.50 b Morphine sulfate 10mg/10ml solution for injection ampoules | 10 ampoule P £15.00–£49.30 b Morphine sulfate 10 mg per 1 ml Morphine sulfate 10mg/1ml solution for injection ampoules | 10 ampoule P £11.87 DT = £11.47 b Morphine sulfate 15 mg per 1 ml Morphine sulfate 15mg/1ml solution for injection ampoules | 10 ampoule P £10.74–£13.10 DT = £10.74 b Morphine sulfate 20 mg per 1 ml Morphine sulfate 20mg/1ml solution for injection ampoules | 10 ampoule P £75.85 DT = £75.85 b Morphine sulfate 30 mg per 1 ml Morphine sulfate 30mg/1ml solution for injection ampoules | 10 ampoule P £14.02 DT = £11.49 b Morphine sulfate 60mg/2ml solution for injection ampoules | 5 ampoule P £10.07 DT = £10.07 b Modified-release capsule CAUTIONARY AND ADVISORY LABELS 2 ▶MXL (Napp Pharmaceuticals Ltd) Morphine sulfate 30 mg MXL 30mg capsules | 28 capsule P £10.91 b Morphine sulfate 60 mg MXL 60mg capsules | 28 capsule P £14.95 b Morphine sulfate 90 mg MXL 90mg capsules | 28 capsule P £22.04 DT = £22.04 b Morphine sulfate 120 mg MXL 120mg capsules | 28 capsule P £29.15 DT = £29.15 b Morphine sulfate 150 mg MXL 150mg capsules | 28 capsule P £36.43 DT = £36.43 b Morphine sulfate 200 mg MXL 200mg capsules | 28 capsule P £46.15 b ▶Zomorph (Ethypharm UK Ltd) Morphine sulfate 10 mg Zomorph 10mg modified-release capsules | 60 capsule P £3.47 DT = £3.47 b Morphine sulfate 30 mg Zomorph 30mg modified-release capsules | 60 capsule P £8.30 DT = £8.30 b Morphine sulfate 60 mg Zomorph 60mg modified-release capsules | 60 capsule P £16.20 DT = £16.20 b Morphine sulfate 100 mg Zomorph 100mg modified-release capsules | 60 capsule P £21.80 DT = £21.80 b Morphine sulfate 200 mg Zomorph 200mg modified-release capsules | 60 capsule P £43.60 DT = £43.60 b Solution for infusion ▶Morphine (Non-proprietary) Morphine sulfate 1 mg per 1 ml Morphine sulfate 50mg/50ml solution for infusion vials | 1 vial P £5.78 DT = £5.78 b | 10 vial P £43.90 b Morphine sulfate 2 mg per 1 ml Morphine sulfate 100mg/50ml solution for infusion vials | 1 vial P £6.48 b | 10 vial P £69.70 b Oral solution CAUTIONARY AND ADVISORY LABELS 2 ▶Morphine (Non-proprietary) Morphine sulfate 2 mg per 1 ml Morphine sulfate 10mg/5ml oral solution | 100 ml P £1.68–£3.00 m | 300 ml P £9.00 DT = £6.21 m | 500 ml P £7.10–£15.00 m ▶Oramorph (Boehringer Ingelheim Ltd) Morphine sulfate 2 mg per 1 ml Oramorph 10mg/5ml oral solution | 100 ml P £1.89 m | 300 ml P £5.45 DT = £6.21 m | 500 ml P £8.50 m Morphine sulfate 20 mg per 1 ml Oramorph 20mg/ml concentrated oral solution sugar-free | 120 ml P £19.50 DT = £19.50 b Modified-release granules CAUTIONARY AND ADVISORY LABELS 2, 13 ▶MST Continus (Napp Pharmaceuticals Ltd) Morphine sulfate 20 mg MST Continus suspension 20mg granules sachets sugar-free | 30 sachet P £24.58 DT = £24.58 b Morphine sulfate 30 mg MST Continus suspension 30mg granules sachets sugar-free | 30 sachet P £25.54 DT = £25.54 b Morphine sulfate 60 mg MST Continus suspension 60mg granules sachets sugar-free | 30 sachet P £51.09 DT = £51.09 b Morphine sulfate 100 mg MST Continus suspension 100mg granules sachets sugar-free | 30 sachet P £85.15 DT = £85.15 b Morphine sulfate 200 mg MST Continus suspension 200mg granules sachets sugar-free | 30 sachet P £170.30 DT = £170.30 b

Source page 508

Clinical care

Extracted information for Morphine only.

Patient And Carer Advice

▶With oral use Patients or carers should be given advice on how to administer morphine modiﬁed-release capsules. Medicines for Children leaflet: Morphine for pain www.medicinesforchildren.org.uk/morphine-pain

Source page 507

Dose text by age group

Filter the extracted dose blocks for this individual drug.

Children

First line only; read the complete Indications and dose section above.

Initially 100–200 micrograms/kg

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 100–200 micrograms/kg

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 200 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 2.5–10 mg every 4 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

100 micrograms/kg every 6 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

100 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

5 mg every 4 hours, adjusted

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 50–100 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

100–150 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

200 micrograms/kg every 4 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 200–300 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 200–300 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 5–10 mg every 4 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Age labels are extracted from the printed dose headings and require clinical review. Confirm current local guidance, dose, route, formulation, contraindications and interactions before prescribing.

Individual generic drug information

morphine

Reference monograph

Part of registered formulation

MORPHINE

Reference record: Morphine
Source: BNF 80 (2020–2021)
Printed source pages: 506, 507, 508
Age groups indexed: 3

Individual active ingredientSource records are displayed separately

Some source sections could not be separated reliably in the extraction. Review the printed source pages when a field is missing or incomplete.

Overview

Extracted information for Morphine only.

Indications And Dose

Source pages 506, 507

Contra Indications

Acute abdomen. delayed gastric emptying. heart failure secondary to chronic lung disease. phaeochromocytoma

Source page 507

Cautions

Cardiac arrhythmias. pancreatitis. severe cor pulmonale

Source page 507

Prescribing And Dispensing Information

Source page 507

Exceptions To Legal Category

Source pages 507, 508

Safety

Extracted information for Morphine only.

Important Safety Information

Do not confuse modiﬁed-release 12-hourly preparations with 24-hourly preparations, see Prescribing and dispensing information.

Source page 507

Interactions

→Appendix 1: opioids Nervous system

Source page 507

Side Effects

Source page 507

Breast Feeding

Therapeutic doses unlikely to affect infant.

Source page 507

Hepatic Impairment

Source page 507

Renal Impairment

Avoid use or reduce dose; opioid effects increased and prolonged; increased cerebral sensitivity.

Source page 507

Monitoring Requirements

Source page 507

Dose and formulations

Extracted information for Morphine only.

Directions For Administration

Source page 507

Medicinal Forms

Source page 508

Clinical care

Extracted information for Morphine only.

Patient And Carer Advice

Source page 507

Dose text by age group

Filter the extracted dose blocks for this individual drug.

Children

First line only; read the complete Indications and dose section above.

Initially 100–200 micrograms/kg

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 100–200 micrograms/kg

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 200 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 2.5–10 mg every 4 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

100 micrograms/kg every 6 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

100 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

5 mg every 4 hours, adjusted

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 50–100 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

100–150 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

200 micrograms/kg every 4 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 200–300 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 200–300 micrograms/kg every

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Children

First line only; read the complete Indications and dose section above.

Initially 5–10 mg every 4 hours,

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 506

Age labels are extracted from the printed dose headings and require clinical review. Confirm current local guidance, dose, route, formulation, contraindications and interactions before prescribing.