Known brand names include MS Contin, Kadian, Duramorph, Infumorph, and Mitigo.
A strong opioid pain reliever given by injection in the hospital or as tablets, for pain severe enough that other treatments are not enough. It can slow or stop breathing and can cause addiction.
The reference opioid for severe acute pain and cancer pain, available IV, IM, and oral. Active metabolites accumulate in renal failure, so hydromorphone or fentanyl is often preferred there. Use only after non-opioid options are inadequate, at the lowest dose for the shortest time.
A full opioid agonist, relatively selective for mu receptors. It has no ceiling for pain relief; dose is limited by respiratory and CNS depression. After an IV dose, the peak CNS effect lags about 30 minutes.
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The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
Doses come from the FDA label. Study tool, not for clinical decisions.
Pharmacokinetics change in renal failure. Start lower than usual and titrate slowly, watching for respiratory depression, sedation, and hypotension.
Serious and life-threatening risks: addiction, abuse, and misuse that can lead to overdose and death; life-threatening respiratory depression, highest at the start and after dose increases; profound sedation, respiratory depression, coma, and death with benzodiazepines, alcohol, or other CNS depressants; and neonatal opioid withdrawal syndrome after prolonged use in pregnancy.
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Naloxone (or nalmefene) for significant respiratory or circulatory depression, after securing the airway and breathing. Reversal wears off before morphine does, so keep monitoring and redose as needed. In opioid-dependent patients, titrate small doses to avoid precipitating severe withdrawal.
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Prolonged use in pregnancy can cause neonatal opioid withdrawal syndrome, which can be life-threatening; plan for neonatal care at delivery. Published studies have not shown a clear link to major birth defects.
Morphine enters breast milk; one study found a milk-to-plasma ratio of 2.5:1. Effects on the infant are not well defined.
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Injection: not established under 18. Tablets: established for acute severe pain in children weighing at least 50 kg; start 15 mg every 4 hours as needed, with no more than 30 mg as a first dose.