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Morphine, the most important alkaloid of opium, is classified pharmacologically as a narcotic analgesic. Morphine Sulfate, USP (pentahydrate), is chemically designated 7, 8-didehydro-4, 5αepoxy-17-methylmorphinan-3, 6α-diol sulfate (2:1) (salt), pentahydrate, a white crystalline powder, soluble in water.

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Morphine Sulfate Injection, USP, is a sterile, nonpyrogenic solution of morphine sulfate in water for injection. This product was designed to be administered by the intravenous route with a compatible Hospira infusion device. For 0.5 mg or 1 mg presentation, each mL contains morphine sulfate, USP (pentahydrate) 0.5 mg or 1 mg, respectively, and sodium chloride, USP, 9 mg in water for injection, USP. May contain sodium hydroxide and/or hydrochloric acid for pH adjustments. For 5 mg presentation, each mL contains morphine sulfate, USP (pentahydrate), 5 mg, sodium chloride, USP, 7.6 mg, with citric acid, USP, anhydrous 0.4 mg and sodium citrate, USP, dihydrate 0.2 mg added as buffers in water for injection, USP. May contain additional citric acid and/or sodium citrate for pH adjustment. The pH range for all preservative-free Morphine Sulfate Injection, USP presentations is 2.5 to 6.5. Morphine Sulfate Injection, USP, contains no antioxidant, bacteriostatic or antimicrobial agent, and is intended only as a single-dose unit, to provide analgesia via the intravenous route, using a compatible Hospira infusion device. Each vial is intended for SINGLE USE ONLY. When the dosing requirement is completed, the unused portion should be discarded in an appropriate manner.

Dosage and Administration

Adults: Morphine sulfate is usually administered by intramuscular or subcutaneous injection, in the range of 5 to 20 mg, depending on the cause of pain and the patient response. Doses may be repeated every 4 to 6 hours. Morphine sulfate may also be given intravenously when a rapid onset of action is desired. The dose is usually in the range of 2.5 to 15 mg diluted in 4 to 5 mL of Water for Injections given slowly over 4 to 5 minutes. Children: Morphine sulfate is given by intramuscular or subcutaneous injection in doses of 0.1 to 0.2 mg/kg bodyweight to a maximum of 15 mg. Injection may be repeated every 4 to 6 hours. When a rapid onset of action is desirable, in a closely monitored environment, morphine may be titrated intravenously with caution, in a dose of 0.05 to 0.1 mg/kg, incrementally over 5 to 15 minutes. Repeat intravenous dosing is unsubstantiated as a method of analgesia in children. Morphine sulfate is not usually given pre-operatively in children under 1 year, and it should be given with extreme care to neonates. It should not be given to premature infants

Uses

Morphine immediate release works quickly. It will usually relieve pain within about 30 minutes. This medication relieves severe pain when less potent pain relievers are not effective. Opioids decrease pain by working on the brain to increase pain tolerance. 

Side Effects

  • decreased coordination
  • fast, slow, or pounding heartbeat
  • hallucinations
  • signs of blocked bowel (e.g., abdominal pain, severe constipation, nausea)
  • skin rash
  • withdrawal symptoms (e.g., nausea, vomiting, diarrhea, anxiety, shivering, cold and clammy skin, body aches, loss of appetite, sweating)

Contraindication
-Cardiac arrhythmias

-Heart failure secondary to pulmonary disease

-Acute alcoholism or delirium tremens

-Head injuries

-Brain tumour

-raised intracranial or cerebrospinal pressure and in convulsive states such as status

epilepticus, tetanus or strychnine poisoning.
-with acute or severe bronchial asthma or other obstructive airways disease

-Respiratory insufficiency or depression, especially in the presence of cyanosis and/orexcessive bronchial secretion

-other conditions where respiratory reserve is depleted, such as severe emphysema, chronic

-biliary colic

-gastrointestinal obstruction

-suspected surgical abdomen

-In patients who are taking or who have taken MAO inhibitors within the previous fourteen days

-Bronchitis or kyphoscoliosis

-Dor pulmonale

-Severe CNS depression

-Diabetic acidosis where there is a danger of coma

-severe liver disease or incipient hepatic encephalopathy

-following biliary tract surgery or surgical anastomosis

Warnings

Therapy should only be initiated by a specialist with experience in chronic pain management and in accordance with guidelines approved by the New Zealand Medical Association. Large doses and/or rapid administration of morphine may produce rapid onset of respiratory depression, bradycardia, or even cardiac arrest. Morphine delays gastric emptying, which may be expected to increase the risks of aspiration, either associated with morphine induced CNS depression or coma, or during or after general anaesthesia. Wiki

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