Morphine dosage information explained

The Morphine dosage information mentioned below can be considered as some suggested doses derived from clinical decisions and again the doses differ based on needs of each individual and his/her medical condition. Always approach your doctor for the right dosage as he can examine your medical conditions and suggest the right dosage of Morphine.

Normal Adult dose – Pain

Tablets- Immediate release

Opioid naïve

Initial dose: 15-30mg to be taken orally after every four hours as required.

Oral Solution- Opioid Naïve

Initial dose: 10-20mg to be taken orally after every 4 hours as required.

Notes

Oral solutions

Opioid naïve patients should be started with the following strengths

10mg per 5ML or 20mg per 5 ML

Patients who are tolerant to opioid and are titrated to a fixed analgesic program using low doses of Morphine can be started on 100mg per 5ML

 

Extended release- oral

Different products (extended release) are not bioequivalent. The product information for each product should be considered before the dosage is been prescribed and accordingly the dosage adjustment should be done for each individual patient.

Opioid tolerant

Dose- to be taken 1-2 times in a day based on the product prescribed

Opioid Naïve

Initial dose

30mg to be taken orally after every 24 hours

Suppository

10-25mg – to be taken rectally after every 4 hours as required.

Subcutaneous/IM

Initial dose:

10mg after every 4 hours as required

Dose range

5-20mg after every 4 hours as required

IV

As preanesthetic and for pain relief

Initial Dose: 4-10mg after every 4 hours managed slowly over 4-5 minutes

Dose range: 5-15 mg

Dose range (Daily): 12-120mg

Alternate dose: 2-10mg for 70 kg of body weight

Dose Adjustments

The dosing schedule of Morphine should be adjusted for every patient individually, considering previous analgesic treatment information. Consider the following before selecting the initial dose

  1. Different preparations of Morphine are not bioequivalent. Before shifting a patient from one form of morphine to another, consult local protocol or product labeling.
  2. The complete daily dose and opioid strength the patient had taken previously.
  3. The level of patient’s opioid tolerance
  4. The medical status and general condition of the patient
  5. Severity and type of pain
  6. Concurrent medications
  7. Risk factors related to diversion, drug abuse, addiction, past history of addiction, abuse or diversion.

In case of cancer patients, rescue doses of oral formulations of immediate release form may be required.

Morphine – Overdose – Treatment

Morphine overdose takes place when a person accidently or intentionally takes morphine in excess. Morphine is a very strong painkiller. In case you notice overdose symptoms call poison control center immediately. In case of overdose the person gets treatments like

  • activated charcoal
  • urine or blood tests are conducted
  • laxative
  • chest X-ray
  • fluids via a vein
  • Naloxone – a medicine used to alter the effect of poison.
  • Airway support given like breathing machine, breathing tube via mouth including oxygen.

In case of overdose if the person stops breathing can die if he doesn’t get medical attention in time.

Is Morphine safe for pregnant women and breastfeeding moms?

Many pregnant women and breastfeeding moms who use morphine aren’t aware of whether it is safe during breastfeeding and pregnancy or not. The article will help you know if morphine is safe for pregnant women and breastfeeding moms.

Morphine and Pregnancy

Published documents say that using morphine during pregnancy is not considered to be safe as morphine intersects the placenta, so if prescribed quite late during labour; it can affect your child’s breathing and cause drowsiness in baby for many days after birth. The baby should be monitored for symptoms of morphine immediately after birth in a separate unit. The side effects of morphine seen in pregnant women are

  1. Restlessness
  2. confusion
  3. drowsiness
  4. hot flushes or heart palpitations
  5. vertigo
  6. disturbed vision
  7. Some women often say that they forget of their baby being born because of the drowsy state induced by morphine.

Prolonged morphine consumption by woman during last three months of pregnancy, regardless of morphine dose can lead to a withdrawal syndrome in new born baby followed by convulsions, vomiting, irritability or enhanced lethality. Therefore morphine is not recommended during pregnancy for mother as well as the baby.

In case you are using morphine occasionally in high doses, chronic treatment and neonatal monitoring is advised to prevent the related risks of withdrawal symptoms and respiratory depression in new born baby.

It is fine if you use low doses of morphine for a short term, especially during your first trimester. If your doctor is aware about your pregnancy and recommends appropriate doses of morphine, then you do not need to worry. Also if your test reports, scans are perfect, it is safe to use morphine.

Certain studies do not indicate any signs of complications even if morphine is used for a prolonged period and doesn’t lead to any effects on your baby or any birth defects, health problems that lasts long, so you need not worry.

Morphine and Breastfeeding

Morphine passes into breast milk and breastfeeding should be stopped while you are on this medication. During breastfeeding, withdrawal symptoms are seen in new born babies when you stop using morphine.

It is always better to avoid the use of morphine while breastfeeding so that it doesn’t harm your baby. Do not use morphine in large amounts or get into drug addiction. Speak to your doctor if he can recommend you other alternative non narcotic medications to relieve pain.

Babies born on drug dependency might need medical treatment for a long period of time. To avoid the fatal withdrawal symptoms in your baby, make sure you do not get addicted to the drug.

Speak to your doctor if you are pregnant or breastfeeding before you use morphine. Your doctor can decide or suggest dose adjustments to help you use the drug safely. Doctor can help you know about other alternative treatments to relieve pain so that morphine doesn’t affect you and your baby’s health.

Do not ignore the side effects of morphine that can cause harm to your baby.

Finding out how Morphine interacts with other drugs

If you are using any other medications apart from Morphine let your doctor know, so that your doctor can judge how other medications are going to interact with Morphine. Let us find out how morphine interacts with other drugs

Morphine can interact with

  • Muscle relaxants
  • CNS depressants
  • MAOIs
  • PGP(P-Glycoprotein inhibitors)
  • Anticholinergics

Let your doctor know if you are using any other non prescription, prescription medications, OTC medications, dietary or nutritional supplements, recreational herbal remedies, and or illegal drugs.

Drug Interactions

CNS depressants

The parallel use of morphine with CNS depressants comprising of tranquilizers, hypnotics, sedatives, phenothiazines, general anesthetics or other opioids and alcohol can enhance the harmful effects like respiratory depression, coma, profound sedation and even death. Patients receiving morphine and CNS depressants should be monitored for signs of hypotension, sedation and respiratory depression.

Muscle Relaxants

Morphine can increase the neuromuscular blocking activity of various muscle relaxants (skeletal) and generate high level of respiratory depression. Patients receiving muscle relaxants and morphine together should be monitored for the signs of high level of respiratory depression.

MAOIs

MAOIs can affect the efficiency of morphine. Patients who are given combination of an MAOI and morphine should be monitored for high level of central nervous system and respiratory depression.  MAOIs affect the morphine anxiety, respiratory depression, coma or confusion. Morphine should not be prescribed to the patients using MAOIs or stopped using the treatment at least for 14 days.

Diuretics

Morphine can decrease the potency of diuretics by instigating the liberation of antidiuretic hormone. Morphine can also cause urinary retention and thus resulting in sphincter spasm of bladder especially in men having enlarged prostates.

Cimetidine

Cimetidine can affect morphine-generated respiratory depression. According to a report a patient undergoing the process of hemodialysis, when administered parallel with cimetidine and morphine reported signs of serious respiratory depression and confusion.

Anticholinergics

Anticholinergics when used simultaneously with opioid analgesics can increase the risk of severe constipation or urinary retention. Patients should be monitored for signs of decreased gastric motility and urinary retention when using morphine and Anticholinergics concurrently.

Mixed Antagonist/Agonist and Partial Agonist- Opioid Analgesics

Mixed Antagonist/Agonist and Partial Agonist (Opioid Analgesics) can lower the efficiency of morphine or increase withdrawal symptoms. Do not use antagonist/agonist or partial analgesics with morphine.

PGP Inhibitors

PGP inhibitors can enhance the absorption of morphine to a large extent. Therefore patients using the two medications together should be monitored for central nervous system or respiratory depression.

Before you start taking morphine consult your health care provider to know about various morphine drug interactions with the medications you are using currently. The medications you are using might interact with morphine to produce harmful effects that you might not be aware of. Make a list of all other medications you are using and share the list with your doctor to avoid complications and use drug safely.

Your doctor can check for ingredients present in medication you are using and can advice you on whether morphine is safe to be used with those medications. Avoid changing your dose or stop taking morphine suddenly.

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