MORPHINE

Strong, centrally acting opioid analgesic

Dosage Forms

Oral solution

5 mg/5 ml
50 mg/5 ml

Concentrated oral solution

20 mg/ml (NR)

Injection

10 mg/ml

Uses

  • Severe pain (acute and chronic)

Dose and Duration

SC injection is not appropriate for oedematous patients

Acute pain

By SC or IM injection:

Adult and child over 12 years: 10 mg every 4 hours if necessary (15 mg for heavier patients)

Child 6–12 years: 5–10 mg every 4 hours if required

Child 1–5 years: 2.5–5 mg every 4 hours if required

Infant 1 month–12 months: 200 micrograms /kg every 4 hours if required

Infant up to 1 month: 150 micrograms/kg every 4hours if required

Chronic pain

By mouth or by SC or IM injection:

Adult: 5–20 mg regularly every 4 hours

Child: 1 mg/kg per day orally every 4 hours

Titrate the dose according to clinical response

Adjust the dose (but not the frequency) to achieve satisfactory pain control

Contraindications

  • Asthma
  • Head injuries and rib fractures
  • Raised intracranial pressure
  • Patients in coma or altered consciousness
  • Uncontrolled epilepsy
  • Prostate disorders
  • Acute alcoholism
  • Delayed gastric emptying
  • Heart failure secondary to lung disease
  • Acute respiratory depression
  • Risk of paralytic ileus

Side Effects

  • Constipation, nausea and vomiting, dry mouth
  • Euphoria, hallucinations, confusion, dependence
  • Low blood pressure
  • Headache, sedation, drowsiness
  • Respiratory depression

Interactions

Increased sedation and respiratory depression can occur with:

  • Alcohol
  • Diazepam
  • Chlorpromazine, romethazine
  • Chlorpheniramine
  • Phenobarbital

Pregnancy

  • Do not use in 3ʳᵈ trimester

Breast-feeding

  • Can be used

Storage

  • Store in a locked cabinet

⚠️ Caution

  • To prevent constipation, always give bisacodyl
  • Do not stop long-term treatment abruptly; reduce dose slowly to avoid withdrawal symptoms
  • Morphine is a controlled medicine (narcotic) and should be handled according to the regulations