Classification
high alert medication
controlled and targeted substance
Opioid analgesic
Indications
PCP: Pain management in palliative or end-of-life emergencies
PCFP/ACP: Moderate to Severe Pain
ACP: Symptom relief in palliative or end-of-life patients with pain or shortness of breath
PCFP/ACFP/CCP: management of moderate to severe pain (infusion)
Contraindications
- Known hypersensitivity to morphine or other opioid analgesics
- Head injury with altered LOC (GCS < 9)
- Hypotension (adult SBP < 90 mmHg; children under 12 SBP < 70 mmHg)
- Respiratory depression (adults < 10 breaths/minute; children under 12 < 20 breaths/minute)
Cautions
- Convulsive disorderes
- Cranial injuries
- Respiratory insufficiency, including asthma, COPD, and upper airway obstruction
- Cardiac arrhythmias
- Reduced blood volume (hypovolemia)
Adult dosages
Dosing for Morphine is based on opioid-naive patients. For patients identified as not opioid-naive, consider consultation with CliniCall for additional analgesia planning support.
PCP: Pain management in palliative emergencies or end-of-life patients
ACP: Symptom relief in palliative or end-of-life patients with pain or shortness of breath
PCFP/ACP: Analgesia
- Intravenous
- 2.5 mg - 5 mg q 5-10 minutes prn
- Consider for use in longer transport times
- PCFP requires consultation with CCP-A or EPOS.
PCFP/ACFP/CCP
- Infusion
- Initial: 0.5 - 4mg/hour and titrate to effect
- Range: 0.5 - 10mg/hour
- PCFP requires consultation with CCP-A or EPOS.
Pediatric Considerations And Dosing
ACP:
- Intravenous
- See Page for Age for weight based dosing
- Administer one dose initially (0.05 mg/kg). May repeat after 5 minute interval as required for pain control. The dose, up to a cumulative 0.1 mg/kg, can be repeated after two hours.
Preparation and Administration
Standard Adult Concentration
- Morphine 1mg/mL
- Morphine 10mg/mL
- Remove 10mL from 50 mL of NS
- Add 500mg morphine to 40mL of NS
How Supplied
Ampoule: 10 mg in 1 mL ampoule
Mechanism Of Action
Binds to opioid receptors in the CNS (primarily mu receptors) causing inhibition of ascending pain pathways, altering the perception of and response to pain and producing generalized CNS depression.
Pharmacokinetics
Intramuscular / subcutaneous:
- Onset: 10 minutes
- Peak: 20-60 minutes (variable)
- Duration: 2-4 hours
Intravenous:
- Onset: 5-10 minutes
- Peak: 20 minutes
- Duration: 2-4 hours
Adverse Effects
- Drowsiness, dizziness, sedation, agitation, euphoria
- Respiratory depression and apnea
- Profound hypotension (may be increased with rapid IV injection), bradycardia
- Nausea, vomiting, constipation
- Pinpoint pupils
- Repeated subcutaneous administration may cause local tissue irritation
- Pseudoallergic reactions (itch, rash) may occur due to direct stimulation of histamine release (anaphylaxis is rare)
Overdose
Provide airway management and ventilatory support. Consider the use of naloxone to reverse opioid intoxication. Naloxone should be used judiciously in patients on long-term opioid therapy to avoid precipitating acute withdrawal syndrome.
See Naloxone guideline.
Drug Interactions
Morphine may enhance respiratory and circulatory depression if used in combination with other opioids, sedatives such as benzodiazepines, phenothiazines, anesthetics, or alcohol.
Do not use morphine in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of MAOI discontinuation.