Morphine (Oral)

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[edit] BRAND NAMES

[edit] STRUCTURE

Morphine.jpg

[edit] MECHANISM OF ACTION

Morphine is a rapid-acting narcotic, and it is known to bind very strongly and relatively selectively to the μ-opioid receptors, although it can interact with other opioid receptors (κ-opioid and δ-opioid receptors) at higher doses. In addition to analgesia, the widely diverse effects of morphine include drowsiness, changes in mood, respiratory depression, decreased gastrointestinal motility, nausea, vomiting, and alterations of the endocrine and autonomic nervous system.

[edit] INDICATIONS

Management of moderate to severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time (e.g. in terminally cancer patients).

[edit] DOSAGE

  • Individualize dosing based on patient’s prior analgesic treatment experience, and titrate as needed to provide adequate analgesia and minimize adverse reactions. Initiate with the 30 mg capsule once daily (at 24-hour intervals). Adjust the dose in increments not greater than 30 mg every 4 days.

[edit] DOSAGE FORMS AND STRENGTHS

Capsules (morphine sulfate: 30 mg, 45 mg, 60 mg, 75 mg, 90 mg, 120 mg (morphine sulfate)

[edit] CONTRAINDICATIONS

  • Significant respiratory depression
  • Acute or severe bronchial asthma
  • Known or suspected paralytic ileus
  • Hypersensitivity (e.g., anaphylaxis) to morphine

[edit] WARNINGS AND PRECAUTIONS

  • Fatal respiratory depression may occur, with highest risk at initiation and with dose increases. Instruct patients on proper administration of Morphine (Oral) to reduce the risk. In elderly, cachectic, and debilitated patients, and patients with chronic pulmonary disease, monitor closely because of increased risk of respiratory depression.
  • Accidental ingestion of Morphine (Oral) can result in fatal overdose of morphine, especially in children.
  • Instruct patients not to consume alcoholic beverages or use prescription or non-prescription products containing alcohol while taking oral Morphine because of the risk of increased, and potentially fatal, plasma morphine levels.
  • Interaction with CNS depressants: Consider dose reduction of one or both drugs because of additive effects.
  • Hypotensive effect: Monitor during dose initiation and titration (Morphine may cause severe hypotension including orthostatic hypotension and syncope in ambulatory patients)
  • Patients with head injury or increased intracranial pressure: Monitor for sedation and respiratory depression. Avoid use of oral morphine in patients with impaired consciousness or coma susceptible to intracranial effects of CO2 retention.

[edit] INTERACTIONS

  • Alcohol: Concomitant use of alcohol with Morphine can result in an increase of morphine plasma levels and potentially fatal overdose of morphine.
  • CNS Depressants: CNS depressants including sedatives, hypnotics, general anesthetics, antiemetics, phenothiazines, other tranquilizers, and alcohol, can increase the risk of respiratory depression, hypotension, profound sedation, or coma.
  • Mixed agonist/antagonist opioid analgesics (i.e., pentazocine, nalbuphine and butorphanol): Avoid use with Morphine because they may reduce analgesic effect or precipitate withdrawal symptoms.
  • Muscle relaxants: Avoid use with morphine because of increased risk of respiratory depression.
  • Monoamine oxidase inhibitors (MAOIs): Avoid Morphine in patients taking MAOIs or within 14 days of stopping such treatment.

[edit] PREGNANCY AND LACTATION

  • Pregnancy Category C (US). Morphine should be given to a pregnant woman only if clearly needed.
  • Nursing Mothers: Morphine is excreted in breast milk. Because of the potential for adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

[edit] SIDE EFFECTS

Most common adverse reactions (≥10%) are constipation, nausea, somnolence, vomiting and headache.

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[edit] REFERENCES