Morphine: Difference between revisions

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==General==
==General==
*Type: [[Opiods]]
*Type: [[Opioids]]
*Dosage Forms: 5, 10, 15, 20, 30, 45, 50, 60, 75, 80, 90, 100, 120, 200, 0.5/ml, 1/ml, 2/ml, 4/ml. 5/ml, 8/ml, 10/ml, 15/ml, 25/ml, 50/ml,  
*Dosage Forms: 5, 10, 15, 20, 30, 45, 50, 60, 75, 80, 90, 100, 120, 200, 0.5/ml, 1/ml, 2/ml, 4/ml. 5/ml, 8/ml, 10/ml, 15/ml, 25/ml, 50/ml,  
*Common Trade Names: Astramorph, AVINza, Duramorph, Infumorph, Kadian, MS contin
*Common Trade Names: Astramorph, AVINza, Duramorph, Infumorph, Kadian, MS contin


==Adult Dosing==
==Adult Dosing==
* Acute pain (Moderate to severe):
*Acute pain (Moderate to severe):
** Oral: 10-30 mg q4hr prn
**Oral: 10-30mg q4hr PRN
** IM: 5-15mg q4hr prn
**IM: 5-15mg
** IV: 2.5-5mg q3hr prn
***Typically not recommended due to erratic absorption
*** AMI: 4-8mg q5-15min prn
***If utilized, no more than one IM dose should be given, due to the danger of "stacking" doses (may lead to respiratory compromise)
*** Critically ill: 2-4mg q1-2hr or 4-8mg q3-4hr prn
**IV: 0.1 mg/kg bolus followed by 0.05 mg/kg q15-20 min until pain controlled
** Continuous infusion IV, SC: 0.8-10mg/hr (up to 80mg/hr)
***Hold further doses for respiratory depression
*** Critically ill: 2-30mg/hr
***Dosed according to ideal body weight
*** PCA 0.5-2.5mg q5-10min prn
***AMI: 4-8mg q5-15min PRN
** Epidural (Preservative free)
***Critically ill: 2-4mg q1-2hr or 4-8mg q3-4hr PRN
*** Single dose: 30-100mcg/kg
**Continuous infusion IV, SC: 0.8-10mg/hr (up to 80mg/hr)
*** Continuous infusion: 0.2-0.4mg/hr
***Critically ill: 2-30mg/hr
*** Continuous microinfusion: 3.5-10mg over 24hrs, titrate to effect (max ~30mg)
***PCA 0.5-2.5mg q5-10min PRN
** Intrathecal (Preservative free)
**Epidural (Preservative free)
*** Single dose: 0.1-03.mg  
***Single dose: 30-100mcg/kg
*** Continuous microinfusion: 0.2-10mg over 24 hours (max ~20mg)
***Continuous infusion: 0.2-0.4mg/hr
** Rectal: 10-20mg q3-4hr
***Continuous microinfusion: 3.5-10mg over 24hrs, titrate to effect (max ~30mg)
**Intrathecal (Preservative free)
***Single dose: 0.1-03.mg  
***Continuous microinfusion: 0.2-10mg over 24 hours (max ~20mg)
**Rectal: 10-20mg q3-4hr
 
==Pediatric Dosing==
==Pediatric Dosing==
* Children >6months and <50kg
*Children >6months and <50kg
* Acute pain (Moderate to severe)
*Acute pain (Moderate to severe)
** Oral: 0.15-0.3mg/kg q3-4hr prn
**Oral: 0.15-0.3mg/kg q3-4hr PRN
** IM, SC: 0.1-0.2mg/kg
**IM, SC: 0.1-0.2mg/kg
** IV: 0.05-0.3mg/kg q3-4hr prn (not to exceed 10mg/dose)
**IV: 0.05-0.3mg/kg q3-4hr PRN (not to exceed 10mg/dose)
** Continuous infusion: 10-30mcg/kg/hr
**Continuous infusion: 10-30mcg/kg/hr
** PCA 0.01-0.03mg/kg/dose and 0-0.03mg/kg/hr
**PCA 0.01-0.03mg/kg/dose and 0-0.03mg/kg/hr


==Special Populations==
==Special Populations==
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*Lactation: Enters breast milk
*Lactation: Enters breast milk
*Renal Dosing
*Renal Dosing
** CrCl 10-50: 75% of normal dose
**CrCl 10-50: 75% of normal dose
** CrCl <10: 50% of normal dose
**CrCl <10: 50% of normal dose
** HD: Child 50%, adult no adjustment
**HD: Child 50%, adult no adjustment
** PD: Child 50%
**PD: Child 50%
** CRRT: Child and adults 75%
**CRRT: Child and adults 75%
*Hepatic Dosing: No adjustment generally (cirrhosis can consider dose adjustment)
*Hepatic Dosing: No adjustment generally (cirrhosis can consider dose adjustment)


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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
* Circulatory depression, shock, cardiac arrest
*Circulatory depression, [[shock]], [[cardiac arrest]]
* Bradycardia, hypotension
*[[Bradycardia]], hypotension
* CNS depression, sedation
*[[CNS depression]], sedation
* Apnea, respiratory arrest/depression
*Apnea, respiratory arrest/depression
* Anaphylaxis, laryngospasm
*Anaphylaxis, laryngospasm
===Common===
===Common===
* Dependence
*Dependence
* ADH release, hypogonadism
*ADH release, hypogonadism
* Drowsiness, dizziness, confusion, headache
*Drowsiness, dizziness, confusion, headache
* Pruritis
*Pruritis
* Xerostomia, constipation, vomiting
*Xerostomia, constipation, vomiting
* Urinary retention
*Urinary retention
* Pancytopenia
*Pancytopenia
* Weakness
*Weakness
* Hypoxia
*Hypoxia
* Histamine release, urticaria
*Histamine release, urticaria
* Afib, tachycardia, edema, chest pain
*[[Afib]], [[tachycardia]], edema, [[chest pain]]
* Abdominal pain
*Abdominal pain


==Pharmacology==
==Pharmacology==
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*Excretion: Urine and feces
*Excretion: Urine and feces
*Mechanism of Action:  
*Mechanism of Action:  
** Binds to opioid receptors in CNS
**Binds to opioid receptors in CNS
** Inhibits ascending pain pathways
**Inhibits ascending pain pathways
** Alters perception and response to pain
**Alters perception and response to pain
** Produces CNS depression
**Produces CNS depression


==See Also==
==See Also==


==Sources==


==References==
<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]]
* UpToDate

Latest revision as of 20:12, 20 February 2021

General

  • Type: Opioids
  • Dosage Forms: 5, 10, 15, 20, 30, 45, 50, 60, 75, 80, 90, 100, 120, 200, 0.5/ml, 1/ml, 2/ml, 4/ml. 5/ml, 8/ml, 10/ml, 15/ml, 25/ml, 50/ml,
  • Common Trade Names: Astramorph, AVINza, Duramorph, Infumorph, Kadian, MS contin

Adult Dosing

  • Acute pain (Moderate to severe):
    • Oral: 10-30mg q4hr PRN
    • IM: 5-15mg
      • Typically not recommended due to erratic absorption
      • If utilized, no more than one IM dose should be given, due to the danger of "stacking" doses (may lead to respiratory compromise)
    • IV: 0.1 mg/kg bolus followed by 0.05 mg/kg q15-20 min until pain controlled
      • Hold further doses for respiratory depression
      • Dosed according to ideal body weight
      • AMI: 4-8mg q5-15min PRN
      • Critically ill: 2-4mg q1-2hr or 4-8mg q3-4hr PRN
    • Continuous infusion IV, SC: 0.8-10mg/hr (up to 80mg/hr)
      • Critically ill: 2-30mg/hr
      • PCA 0.5-2.5mg q5-10min PRN
    • Epidural (Preservative free)
      • Single dose: 30-100mcg/kg
      • Continuous infusion: 0.2-0.4mg/hr
      • Continuous microinfusion: 3.5-10mg over 24hrs, titrate to effect (max ~30mg)
    • Intrathecal (Preservative free)
      • Single dose: 0.1-03.mg
      • Continuous microinfusion: 0.2-10mg over 24 hours (max ~20mg)
    • Rectal: 10-20mg q3-4hr

Pediatric Dosing

  • Children >6months and <50kg
  • Acute pain (Moderate to severe)
    • Oral: 0.15-0.3mg/kg q3-4hr PRN
    • IM, SC: 0.1-0.2mg/kg
    • IV: 0.05-0.3mg/kg q3-4hr PRN (not to exceed 10mg/dose)
    • Continuous infusion: 10-30mcg/kg/hr
    • PCA 0.01-0.03mg/kg/dose and 0-0.03mg/kg/hr

Special Populations

  • Pregnancy Rating: C
  • Lactation: Enters breast milk
  • Renal Dosing
    • CrCl 10-50: 75% of normal dose
    • CrCl <10: 50% of normal dose
    • HD: Child 50%, adult no adjustment
    • PD: Child 50%
    • CRRT: Child and adults 75%
  • Hepatic Dosing: No adjustment generally (cirrhosis can consider dose adjustment)


Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

  • Dependence
  • ADH release, hypogonadism
  • Drowsiness, dizziness, confusion, headache
  • Pruritis
  • Xerostomia, constipation, vomiting
  • Urinary retention
  • Pancytopenia
  • Weakness
  • Hypoxia
  • Histamine release, urticaria
  • Afib, tachycardia, edema, chest pain
  • Abdominal pain

Pharmacology

  • Half-life: Immediate release 2-4hrs; Avinza 24hrs; Kadian 11-13hrs
  • Metabolism: Hepatic
  • Excretion: Urine and feces
  • Mechanism of Action:
    • Binds to opioid receptors in CNS
    • Inhibits ascending pain pathways
    • Alters perception and response to pain
    • Produces CNS depression

See Also

References

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