MORPHINE

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Created Jul 2020 | Updated Oct 2020

MORPHINE

  • [MS CONTIN]
  • [ROXANOL]
  • [ORAMORPH]
  • [RMS]
  • [MSIR]

DEA CODE 9300: Schedule 2 Narcotic

Morphine

Morphine

Morphine is an opiate used to relieve severe pain. Named after Morpheus, the Greek god of dreams, morphine provides a feeling of euphoria oft-described as a dreamlike state. The drug can be taken in the form of a tablet, syrup, or injection. In some cases, morphine can even be smoked. Morphine has the potential to be highly addictive, as tolerance to it develops rapidly. A federally designated Schedule II drug, morphine is used to treat moderate, severe, and chronic pain. It is also used for pain relief after major surgeries, treatment for cancer-related pain, and shortness of breath at the end of a patient's life. However, morphine also runs a high potential of abuse because of its pleasurable effects and relative accessibility. In recent years, morphine pills have added abuse deterrent coding so that they cannot be crushed, snorted, or injected. While this has reduced the addictive potential of prescribed morphine, it has not eliminated its potential and it has not impacted illicitly manufactured morphine. Some of the common street or slang names for morphine include M, Miss Emma, monkey, roxanol and white stuff. Morphine is a naturally occurring substance extracted from either the opium poppy plant or concentrated poppy straw. Its chemical makeup is similar to heroin, as they are both extracted from the same plant.

What is Morphine?
Morphine is the most abundant analgesic opiate found in opium and is a potent pain reliever. The drug is used in clinical pain relief but is also used illicitly for recreational purposes among drug users. It is potentially highly addictive and can cause intense physical dependence that leads to abuse of the substance. Morphine is obtained from the seedpod extract or opium found in the poppy plant, Papaver somniferum. Morphine is widely used in clinical pain management, especially for terminal cancer pain and post-surgery pain. In the body, morphine has several effects including reduction of pain, loss of hunger, and suppression of cough.

Some of the clinical uses of morphine include:

  • Pain relief after surgery
  • Pain relief after major trauma or injury except head injuries
  • Pain relief in advanced cancers with terminal cancer pain
Due to the euphoric effects of the drug, morphine is also commonly used illegally by drug abusers. Some of the street names for morphine include God's Drug, MS, Morf, Morpho, Dreamer, First Line, Emsel, Unkie and Mister Blue. In previous decades, the injectable form of morphine was most commonly used. However, today it is taken in the form of a pill, a drinkable solution or a suppository.

Prescribed as:
Kadian, MS-Contin, Oramorph SR, MSIR, RMS, Roxanol. Very effective for pain relief, high potential for abuse. Street Names: Dreamer, Emsel, First Line, God's Drug, Hows, MS, Mister Blue, Morpho, Unkie

Brand Names: US
Arymo ER; Duramorph; Infumorph 200; Infumorph 500; Kadian; Mitigo; MorphaBond ER [DSC]; MS Contin

Brand Names: Canada
BAR-Morphine SR; Doloral 1; Doloral 5; Kadian; Kadian SR; M-Ediat; M-Eslon; Morphine Extra Forte [DSC]; Morphine Forte [DSC]; Morphine HP; Morphine LP Epidural; Morphine SR; Morphine Sulfate SDZ; Morphine-Epd [DSC]; MS Contin; MS/IR; RATIO-Morphine [DSC]; Ratio-Morphine [DSC]; SANDOZ Morphine SR; Statex; TEVA-Morphine SR

Morphine Overview:
Morphine, narcotic analgesic drug used in medicine in the form of its hydrochloride, sulfate, acetate, and tartrate salts. Morphine was isolated from opium by the German chemist F.W.A. Serturner in about 1804. In its power to reduce the level of physical distress, morphine is among the most important naturally occurring compounds, being of use in the treatment of pain caused by cancer and in cases where other analgesics have failed. It also has a calming effect that protects the system against exhaustion in traumatic shock, internal hemorrhage, congestive heart failure, and debilitated conditions (as certain forms of typhoid fever). It is most frequently administered by injection to ensure rapid action, but it is also effective when given orally. Morphine produces a relaxed, drowsy state and many side effects that result from the depression of the respiratory, circulatory, and gastrointestinal systems. It also is an emetic and a general depressant. The most serious drawback to the drug is its addictiveness.

What is the most important information I should know about Morphine?
MISUSE OF OPIOID MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medication in a place where others cannot get to it.
Taking opioid medicine during pregnancy may cause life-threatening withdrawal symptoms in the newborn.
Fatal side effects can occur if you use opioid medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

Morphine Timeline:

1806 Morphine is first isolated.
Early 1850s First experimentation with injecting medications.
1853 Hypodermic needle-syringes with a point fine enough to pierce the skin are invented simultaneously by Charles Gabriel Pravaz (French surgeon) and Alexander Wood (Scottish physician). It is first used to inject morphine intravenously.
1861 Commercially manufactured hypodermic syringes are available in Europe and America. (A Brief History of Cocaine)
1906 Pure Food and Drug Act is passed, regulating the labeling of products containing Alcohol, Opiates, Cocaine, and Cannabis, among others. The law went into effect Jan 1, 1907

- https://erowid.org/pharms/morphine/morphine_timeline.php

Common concerns about giving morphine to children:
Safety
Morphine and other opioids are safe to give to children, even newborns. All hospitals have very strict procedures to make sure that the right amount of any drug is given. The size, age, and condition of a child are always taken into account when deciding the amount of morphine a child needs. These measures mean the chance of giving too much of a drug (overdose) is low.

Key points:

  • It is better to prevent pain than to treat it once it has started.
  • Morphine is a safe and effective pain-relieving medicine, even for children and babies.
  • The side effects of morphine are usually mild and can be prevented.
  • Morphine provides more effective pain relief than codeine.
  • For more information, speak to your child's doctor, nurse, or pharmacist.

Contraception and pregnancy
This treatment may harm a baby developing in your womb. It is important not to become pregnant while you are having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding:
Don't breastfeed during this treatment because the drug may come through into your breast milk.

Breastfeeding:

Summary of Use During Lactation:
Epidural morphine given to mothers for postcesarean section analgesia results in trivial amounts of morphine in their colostrum and milk.

Intravenous or oral doses of maternal morphine in the immediate postpartum period result in higher milk levels than with epidural morphine.

Labor pain medication may delay the onset of lactation.

Maternal use of oral narcotics during breastfeeding can cause infant drowsiness, central nervous system depression and even death, although low-dose morphine might be preferred over other opiates.

Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics.

Once the mother's milk comes in, it is best to provide pain control with a nonnarcotic analgesic and limit maternal intake of morphine to a 2 to 3 days at a low dosage with close infant monitoring, especially in the outpatient setting.

If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.

Drug Levels:
Morphine is metabolized to inactive morphine-3-glucuronide (60%) and to active morphine-6-glucuronide (10%). Morphine has an oral bioavailability of about 30% in adults. Morphine-6-glucuronide has an oral bioavailability of about 4%, but is probably converted back to morphine in the infant's gut and absorbed as morphine. The plasma clearance of morphine is prolonged in very young infants compared to older infants and children. Usual therapeutic intravenous doses of morphine in infants are 10 mcg/kg/hour or 50 to 100 mcg/kg as a single dose. Usual single oral doses of morphine in infants are 100 to 500 mcg/kg.

Effects on Lactation and Breastmilk:

Morphine can increase serum prolactin.

However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Alternate Drugs to Consider:


Morphine is one of the most important and widely used opioid for the treatment of chronic and acute pain: the very wide interindividual variability in the patients' response to the drug may have genetic derivations. Sulphate salt of morphine sold under the many brand names, one of them, DURAMORPH, which is indicated for the management of pain severe enough to require use of an opioid analgesic by intravenous administration, and for which alternative treatments are not expected to be adequate. In addition for the epidural or intrathecal management of pain without attendant loss of motor, sensory, or sympathetic function. Morphine is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of morphine is analgesia. Like all full opioid agonists, there is no ceiling effect for analgesia with morphine. The precise mechanism of the analgesic action is unknown. However, specific CNS opioid receptors for endogenous compounds with opioid-like activity have been identified throughout the brain and spinal cord and are thought to play a role in the analgesic effects of this drug. Morphine has a high potential for addiction and abuse. Common side effects include drowsiness, vomiting, and constipation. Caution is advised when used during pregnancy or breast-feeding, as morphine will affect the baby.

Morphine drug usage

155th most prescribed medicine in the United States for 2017

Tolerance:
If you use morphine for a longer period of time, you may need higher or more frequent doses to get the same pain-relief effects.

Caution:
If your body becomes tolerant to morphine, it doesn't mean you're tolerant to other opioids. If your doctor switches you to another opioid, they must calculate a new dose to avoid an overdose. Don't change your dose without talking with your doctor.

How Long Does Morphine Last?
Morphine has a short half-life, with half of it metabolized in 1.5 to 7 hours. Most of a single dose of morphine is eliminated in the urine within 72 hours.

How Long Does Morphine Stay in Your System?

  • Blood: Up to 3 days
  • Urine: Up to 4 days
  • Saliva: Up to 3 days
  • Hair: Up to 90 days

Morphine
Duration:

The prototypical opioid drug, a powerful analgesic with euphoric qualities, found in the seeds and wax of the plant papaver somniferum (opium poppy). First isolated by Friedrich Serturner in 1805, named for its sleep-inducing qualities. Do not combine with other depressants, may cause dangerous respiratory depression in overdose.

RouteOnsetDurationAfter Effects
Tripsit Factsheets
IV / IM:0-1 minutes2-4 hours1-12 hours
Plugged:10-30 minutes3-4 hours1-12 hours
Insufflated:10-30 minutes4-5 hours1-12 hours
Oral_ER:40-80 minutes4-10 hours1-12 hours
Oral_IR:10-30 minutes4-6 hours1-12 hours
Morphine Duration
Effects:
Euphoria, Dry Mouth, Mood lift, Itchiness, Relaxant, Constipation, Pupil constriction, Analgesia.

Prescribed for:

    What Conditions does it Treat?
  • Excessive pain
  • Pain
  • Severe chronic pain with opioid tolerance
  • Severe chronic pain requiring long-term opioid treatment
  • Severe pain with opioid tolerance

Uses:
This medication is used to help relieve moderate to severe pain. Morphine belongs to a class of drugs known as opioid analgesics. It works in the brain to change how your body feels and responds to pain.

Before using:
Tell your doctor or pharmacist your medical history, especially of:

  • Brain disorders (such as head injury, tumor, seizures)
  • Breathing problems (such as asthma, sleep apnea, chronic obstructive pulmonary disease-COPD)
  • Kidney disease
  • Liver disease
  • Mental/mood disorders (such as confusion, depression)
  • Personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol)
  • Stomach/intestinal problems (such as blockage, constipation, diarrhea due to infection, paralytic ileus)
  • Difficulty urinating (such as due to enlarged prostate)
  • Disease of the pancreas (pancreatitis)
  • Gallbladder disease

Precautions:

  • This drug may make you dizzy or drowsy
  • Alcohol or marijuana (cannabis) can make you more dizzy or drowsy
  • Do not drive, use machinery, or do anything that needs alertness until you can do it safely.
  • Avoid alcoholic beverages.
  • Talk to your doctor if you are using marijuana (cannabis).

Liquid products may contain sugar, aspartame, and/or alcohol. Caution is advised if you have diabetes, alcohol dependence, liver disease, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.

WA INGS:

Morphine has a risk for abuse and addiction, which can lead to overdose and death.

Morphine may also cause severe, possibly fatal, breathing problems.

To lower your risk, your doctor should have you take the smallest dose of morphine that works, and take it for the shortest possible time.

The risk for severe breathing problems is higher when you start this medication and after a dose increase, or if you take the wrong dose/strength.

Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems may cause very serious side effects, including death.

Be sure you know how to take morphine and what other drugs you should avoid taking with it.

Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.

The higher strength of morphine liquid (20 milligrams per milliliter) should be used only if you have been regularly taking moderate to large amounts of an opioid pain medication. This strength may cause overdose (even death) if taken by a person who has not been regularly taking opioids.

Do not confuse the dose of morphine liquid in milligrams (mg) with the dose in milliliters (mL).

User Reviews:

507 Total User Reviews
Morphine Oral Read Reviews
Condition: Pain (355 Reviews):
Effectiveness(3.42)

Ease of Use(4.23)

Satisfaction(3.27)

Liver:
Morphine has not been linked to serum enzyme elevations during therapy or to clinically apparent liver injury.

Morphine Hepatotoxicity:
Morphine has not been linked to serum enzyme elevations during therapy or to clinically apparent liver injury. Therapy with morphine has not been linked to serum enzyme elevations. Hepatitis B and C are common among persons with opiate addiction and illicit injection drug use, but the opiates themselves appear to have little hepatotoxic potential. There have been no convincing cases of idiosyncratic acute, clinically apparent liver injury attributed to morphine. Morphine and other opiates have little hepatic metabolism and they are generally excreted unchanged in the urine, perhaps accounting for their relative lack of hepatotoxicity.

Interactions
Morphine is dangerous to use in combination with other depressants as many fatalities reported as overdoses are caused by interactions with other depressant drugs like alcohol or benzodiazepines, resulting in dangerously high levels of respiratory depression.

Morphine Interactions

Interactions:

Drug Interactions (411) Alcohol/Food Interactions (1) Disease Interactions (17)


What other drugs will affect Morphine?
Opioid medication can interact with many other drugs and cause dangerous side effects or death.

Be sure your doctor knows if you also use:

  • other narcotic medications - opioid pain medicine or prescription cough medicine
  • a sedative like:
  • drugs that make you sleepy or slow your breathing - a sleeping pill, muscle relaxer, tranquilizer, antidepressant, or antipsychotic medicine
  • drugs that affect serotonin levels in your body - a stimulant, or medicine for depression, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting
This list is not complete. Other drugs may interact with morphine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here.

A total of 411 drugs are known to interact with Morphine.

  • 117 major drug interactions
  • 286 moderate drug interactions
  • 8 minor drug interactions

Important Information
You should not take morphine if you have severe asthma or breathing problems, a blockage in your stomach or intestines, or a bowel obstruction called paralytic ileus.

Morphine can slow or stop your breathing, and may be habit-forming MISUSE OF OPIOID MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Keep the medication in a place where others cannot get to it.

Taking opioid medicine during pregnancy may cause life-threatening withdrawal symptoms in the newbo .

Fatal side effects can occur if you use opioid medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how this medicine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries.

Morphine side effects:
Get emergency medical help if you have signs of an allergic reaction to morphine: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Call your doctor at once if you have:

  • slow heart rate, sighing, weak or shallow breathing, breathing that stops during sleep;
  • chest pain, fast or pounding heartbeats;
  • extreme drowsiness, feeling like you might pass out; or
  • nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Serious side effects may be more likely in older adults and those who are malnourished or debilitated.

IMPORTANT WARNING:
Morphine may be habit forming, especially with prolonged use. Take morphine exactly as directed. Do not take more of it, take it more often, or take it in a different way than directed by your doctor. While you are taking morphine, discuss with your healthcare provider your pain treatment goals, length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse morphine if you have or have ever had any of these conditions. Talk to your healthcare provider immediately and ask for guidance if you think that you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

Morphine may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Your doctor will adjust your dose carefully to control your pain and decrease the risk that you will experience serious breathing problems. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor may tell you not to take morphine. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of lung diseases that includes chronic bronchitis and emphysema), a head injury, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weakened or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.

Taking certain other medications during your treatment with morphine may increase the risk that you will experience breathing problems or other serious, life-threatening breathing problems, sedation, or coma. Tell your doctor if you are taking or plan to take any of the following medications: benzodiazepines such as alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), and triazolam (Halcion); cimetidine (Tagamet); other narcotic pain medications; medications for mental illness or nausea; muscle relaxants; sedatives; sleeping pills; or tranquilizers. Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take morphine with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.

Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with morphine increases the risk that you will experience breathing problems or other serious, life-threatening side effects. If you are taking Avinza brand long-acting capsules, it is especially important that you do not drink any drinks that contain alcohol or take any prescription or nonprescription medications that contain alcohol. Alcohol may cause the morphine in Avinza brand long-acting capsules to be released in your body too quickly, causing serious health problems or death. Do not drink alcohol, take any prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment with other morphine products.

Do not allow anyone else to take your medication. Morphine may harm or cause death to other people who take your medication, especially children. Keep morphine in a safe place so that no one else can take it accidentally or on purpose. Be especially careful to keep morphine out of the reach of children. Keep track of how many tablets, or capsules, or how much liquid is left so you will know if any medication is missing. Dispose of any unneeded morphine capsules, tablets, or liquid properly according to instructions. (See STORAGE and DISPOSAL.)

Swallow the extended-release tablets or capsules whole. Do not split, chew, dissolve, or crush them. If you swallow broken, chewed, crushed, or dissolved extended-release tablets or capsules, you may receive too much morphine at once instead of receiving the medication slowly over time. This may cause serious breathing problems or death. If you are unable to swallow the capsules whole, follow the instructions in the ''HOW should this medication be used?'' section below to dissolve the capsule contents in applesauce.

Morphine oral solution (liquid) comes in three different concentrations (amount of medication contained in a given amount of solution). The solution with the highest concentration (100 mg/5 mL) should only be taken by people who are tolerant (used to the effects of the medication) to opioid medications. Each time you receive your medication, check to be sure that you receive the solution with the concentration prescribed by your doctor. Be sure that you know how much medication you should take and how to measure your dose.

Tell your doctor if you are pregnant or plan to become pregnant. If you take morphine regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with morphine and each time you fill your prescription if a Medication Guide is available for the morphine product you are taking. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

Descriptions:
Morphine tablet is used to relieve short-term (acute) or long-term (chronic) moderate to severe pain. The extended-release capsule and extended-release tablet are used to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and when other pain medicines did not work well enough or cannot be tolerated. Morphine belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

Morphine extended-release capsules and extended-release tablets should not be used if you need pain medicine for just a short time, such as when recovering from surgery. Do not use this medicine to relieve mild pain, or in situations when non-narcotic medication is effective. This medicine should not be used to treat pain that you only have once in a while or 'as needed'.

When morphine is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

This medicine is available only under a restricted distribution program called the Opioid Analgesic REMS (Risk Evaluation and Mitigation Strategy) program.

This product is available in the following dosage forms:

  • Tablet, Extended Release
  • Tablet
  • Capsule, Extended Release, 24 HR
  • Solution
  • Capsule, Extended Release

Key Facts:

  • Morphine works by blocking pain signals from travelling along the nerves to the brain.
  • The most common side effects of morphine are constipation, feeling sick and sleepiness.
  • It's possible to become addicted to morphine, but this is rare if you're taking it to relieve pain and your doctor is reviewing your treatment regularly.
  • It may be best not to drink alcohol while taking morphine as you're more likely to get side effects like feeling sleepy.
  • Morphine is also called by the brand names MST, Zomorph, Sevredol, Morphgesic, MXL or Oramorph.

Morphine
Maximum Dosage:
Prescribers Digital Reference
AdultsImmediate-release formulations, extended-release tablets, extended-release capsules (Kadian ONLY), injectable solution (NOT DepoDur): With appropriate dosage titration, there is no maximum dose. Extended-release capsules (Avinza ONLY): 1600 mg/day PO due to the high concentrations of fumaric acid in the formulation. DepoDur liposome injection: 15 mg/dose epidurally. Deodorized opium tincture (10 mg/mL concentration ONLY): 6 mg/dose PO and 24 mg/day PO total. Camphorated opium tincture (0.4 mg/mL concentration ONLY): 4 mg/dose PO and 16 mg/day PO total.
GeriatricImmediate-release formulations, extended-release tablets, extended-release capsules (Kadian ONLY), injectable solution (NOT DepoDur): With appropriate dosage titration, there is no maximum dose. Extended-release capsules (Avinza ONLY): 1600 mg/day PO due to the high concentrations of fumaric acid in the formulation. DepoDur liposome injection: 15 mg/dose epidurally. Deodorized opium tincture (10 mg/mL concentration ONLY): 6 mg/dose PO and 24 mg/day PO total. Camphorated opium tincture (0.4 mg/mL concentration ONLY): 4 mg/dose PO and 16 mg/day PO total.
AdolescentsImmediate-release formulations, extended-release tablets (MS Contin ONLY), injectable solution (NOT DepoDur): With appropriate dosage titration, there is no maximum dose. Extended-release capsules, extended-release tablets (Arymo ER or Morphabond), DepoDur liposome injection: Safety and efficacy have not been established. Deodorized opium tincture (10 mg/mL concentration ONLY): Safety and efficacy have not been established. Camphorated opium tincture (0.4 mg/mL concentration ONLY): 0.2 mg/kg/dose PO (Max: 4 mg/dose) and 0.8 mg/kg/day PO (Max: 16 mg/day).
ChildrenImmediate-release formulations, extended-release tablets (MS Contin ONLY), injectable solution (NOT DepoDur): With appropriate dosage titration, there is no maximum dose. Extended-release capsules, extended-release tablets (Arymo ER or Morphabond), DepoDur liposome injection: Safety and efficacy have not been established. Deodorized opium tincture (10 mg/mL concentration ONLY): Safety and efficacy have not been established. Camphorated opium tincture (0.4 mg/mL concentration ONLY): 0.2 mg/kg/dose PO (Max: 4 mg/dose) and 0.8 mg/kg/day PO (Max: 16 mg/day).
InfantsImmediate-release formulations, injectable solution (NOT DepoDur): With appropriate dosage titration, there is no maximum dose. Extended-release formulations, DepoDur liposome injection: Safety and efficacy have not been established. Deodorized opium tincture (10 mg/mL concentration ONLY): Safety and efficacy have not been established. Camphorated opium tincture (0.4 mg/mL concentration ONLY): Safety and efficacy have not been established.
NeonatesImmediate-release formulations, injectable solution (NOT DepoDur): With appropriate dosage titration, there is no maximum dose. Extended-release formulations, DepoDur liposome injection: Safety and efficacy have not been established. Deodorized opium tincture (10 mg/mL concentration ONLY): Safety and efficacy have not been established. Camphorated opium tincture (0.4 mg/mL concentration ONLY): Safety and efficacy have not been established.

Morphine (Rx)
Black Box Wa ings:
Infumorph not recommended for single-dose intravenous, intramuscular or subcutaneous administration due to associated risk of overdosage

Improper or erroneous substitution of infumorph 200 or 500 (10-25 mg/mL, respectively for regular duramorph (0.5 or 1 mg/mL) could result in serious overdosage leading to seizures, respiratory depression and, possibly fatal outcome

Intrathecal dosage is usually 1/10 that of epidural dosage

Observe patient in a fully equipped and staffed environment for at least 24 hr after initial epidural or intrathecal dose

Naloxone injection and resuscitative equipment should be immediately available for administration, when administering duramorph or infumorph, to treat life-threatening or intolerable side effects

Inspect drug products for particular matter before opening amber ampule, and again for color after removing contents from ampule; after removal do not use unless solution is colorless or pale yellow; the 100 mg/5 mL oral solution is indicated for use in opioid tolerant patients only

Opioid analgesic risk evaluation and mitigation strategy (REMS)
  • To ensure that benefits of opioid analgesics outweigh risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products; under requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers Healthcare providers are strongly encouraged to
Addiction, abuse, and misuse
  • Risk of opioid addiction, abuse, and misuse, which can lead to overdose and death
  • Assess each patient's risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions
Life-threatening respiratory depression
  • Serious, life-threatening, or fatal respiratory depression may occur
  • Monitor for respiratory depression, especially during initiation or following a dose increase
  • Instruct patients to swallow tablet/capsule whole; crushing, chewing, or dissolving can cause rapid release and absorption of a potentially fatal dose
Accidental exposure
  • Accidental ingestion of even 1 dose, especially by children, can result in a fatal overdose
  • Accidental skin espoxure to Duramorph, Astramorph/PF, or Infumorph should be rinsed with water; remove contaminated clothing
Neonatal opioid withdrawal syndrome
  • Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts
  • Syndrome presents as irritability, hyperactivity and abnormal sleep patte , high pitched cry, tremor, vomiting, diarrhea and failure to gain weight
  • Onset, duration, and severity of neonatal opioid withdrawal syndrome vary based on the specific opioid used, duration of use, timing and amount of last mate al use, and rate of elimination of the drug by the newbo
  • If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available
Alcohol interaction
  • Instruct patients not to consume alcoholic beverages or use alcohol-containing drug products while taking morphine due to risk of additive sedation and respiratory depression
  • Coingestion of alcohol with opioid analgesics may increase plasma opioid levels and potentially result in fatal overdose
  • Some long-acting products (ie, Kadian) should not be administered with alcoholic beverages or ethanol-containing products as it may alter the characteristics of the extended-release product and cause rapid release and absorption of a potentially fatal dose
Central nervous system (CNS) depressants
  • Coadministration with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death
  • Reserve concomitant prescribing for use in patients for whom alte ative treatment options are inadequate; limit dosages and durations to the minimum required; and follow patients for signs and symptoms of respiratory depression and sedation
  • Instruct patients not to consume alcoholic beverages or use alcohol-containing drug products while taking morphine due to risk of additive sedation and respiratory depression

MS Contin (morphine sulphate)
Side Effects:
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
RxList
Opioid medicine can slow or stop your breathing, and death may occur. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.
Call your doctor at once if you have:
  • slow heart rate, sighing, weak or shallow breathing, breathing that stops during sleep
  • chest pain, fast or pounding heartbeats
  • extreme drowsiness, feeling like you might pass out
  • low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness
Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Serious side effects may be more likely in older adults and those who are malnourished or debilitated.
Long-term use of opioid medication may affect fertility (ability to have children) in men or women. It is not known whether opioid effects on fertility are permanent.
Common side effects may include:
  • drowsiness, dizziness, tiredness
  • constipation, stomach pain, nausea, vomiting
  • sweating
  • feelings of extreme happiness or sadness
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Medsafe PDF Morphine

Related Substances:
Created Jul 2020

MORPHINE COMBINATION PRODUCT

/50 MG/(100 ML OR 100 GM)

DEA CODE 9810: Schedule 3 Narcotic:

Morphine is a Schedule 2 narcotic. A morphine combination product is a Schedule 3.

Created Jul 2020

MORPHINE METHYLBROMIDE

  • [MORPHINE METHOBROMIDE]
  • [MORPHINE BROMOMETHYLATE]
  • [MORPHOSAN]

DEA CODE 9305: Schedule 1 Narcotic:

Schedule 1 Narcotic.
It is a salt of morphine with a freebase conversion ratio of 0.75.
2014 aggregate national production quota of 5 grams.

Created Aug 2020

MORPHINE METHYLSULFONATE

DEA CODE 9306: Schedule 1 Narcotic:

Morphine Methylsulfonate is a derivative of Morphine (M652285), which is the principle alkaloid of opium and an analgesic used to treat both acute and chronic pain.

Created Aug 2020

MORPHINE-N-OXIDE

  • [GENOMORPHIN]

DEA CODE 9307: Schedule 1 Narcotic:

an active opioid metabolite of morphine pharmaceutical that is no longer in common use. annual production quota of 655 grams in 2013.

  
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Wednesday February 01, 2023 - abcnews.go.com

Morphine-Siphoning Nurse Gets Jail For Stealing Drug From Northborough Dementia Patients: Feds - Provided by Daily Voice Hampshire & Franklin Counties A nurse removes a drug from a vial. Gwen Rider, a former Northborough nursing home nurse who admitted to stealing morphine from her patients ...
Friday January 13, 2023 - msn.com

Suspected drug smuggler arrested with 1 kg of morphine in UP's Barabanki - Police arrested a suspected drug smuggler and recovered more than 1 kg of morphine from him in Barabanki district in Uttar Pradesh, an officer said on Wednesday. The accused, identified as Munnawar, ...
Tuesday January 31, 2023 - theweek.in

Theatre review: The Priestess of Morphine, Blue Room Theatre - Those who enjoy tales of queerness, nearness and the darkness of bottomless drug spirals, would more than adore The Priestess of Morphine.
Monday February 06, 2023 - artshub.com.au

Drug overdoses are shooting up at an alarming rate in Minnesota youth - ROCHESTER, Minn. - Drug overdoses are continuing to be on the rise amid the ongoing opioid epidemic, and some of these overdoses are starting to appear in younger crowds.
Monday February 06, 2023 - kimt.com

Vancouver Embarks on Bold Experiment to Decriminalize Hard Drugs - Possession of small amounts of fentanyl, heroin, cocaine and other hard drugs will be allowed in Canada’s westernmost province.
Sunday January 29, 2023 - bloomberg.com

British Columbia becomes first province in Canada to decriminalize heroin, fentanyl, cocaine, other hard drugs - British Columbia became the first province in the country to decriminalize a certain amount of hard drugs as the country deals with a spike in drug overdoses.
Monday January 30, 2023 - msn.com

Opioids Drug Market Share and Growth 2023 | with Increasing Demand, Business Developments, Opportunities and Challenges Forecast to 2027 - Opioids Drug Market” Qualitative Research Report 2023-2027 offers an crucial insights into key price chain analysis ...
Monday January 30, 2023 - marketwatch.com

Barkly mayor Jeff McLaughlin faces new drug driving charge - which includes cannabis and prescription drugs fentanyl and morphine, and possessing less than a commercial quantity of a Schedule 2 drug. Deputy Mayor Dianne Stokes took over as acting mayor at the ...
Monday February 06, 2023 - thechronicle.com.au

The Partnership for a Drug-Free New Jersey Warns Parents about the Dangers of Opioid Prescribing for Wisdom Tooth Removal in New PSA Campaig - It is the number one cause of overdose deaths in the United States. Fentanyl is powerful and is 50 to 100 times more potent than morphine. Illegal street drugs containing fentanyl are on the rise and ...
Tuesday January 31, 2023 - benzinga.com

Canada province experiments with decriminalising hard drugs - Canada's province of British Columbia is starting a first-in-the-nation trial decriminalising small amounts of hard drugs such as cocaine and heroin. From Tuesday, adults can possess up to 2.5g of ...
Monday January 30, 2023 - yahoo.com

Ambulances service turned up to emergencies without life-saving drugs - Ambulances in the North East frequently turned up to emergencies without life-saving drugs, a damning inspection report found. Poor management of medicines at North East Ambulance Service NHS Trust ...
Tuesday January 31, 2023 - aol.com

  
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