11/9/2018 Morphine: Indication, Dosage, Side Effect, Precaution | MIMS.

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Morphine
> Indications > Adverse Drug Reactions
> Dosage > Pregnancy Category (US FDA) Other Known Brands
> Dosage Details > Patient Counselling MST Contin...
> Renal Impairment > Monitoring Parameters
> Hepatic Impairment > Overdosage
> Administration > Drug Interactions
> Incompatibility > Food Interaction
> Contraindications > Mechanism of Action
> Special Precaution > Storage
> MIMS Class

Indications Listed in Dosage.

Dosage Adult : PO Moderate to severe pain 5-20 mg 4 hrly. Extended-release: 5-20 mg 12 hrly. IV Pain
associated w/ MI 5-10 mg at 1-2 mg/min followed by a further 5-10 mg as necessary. Acute pulmonary
oedema 5-10 mg via slow inj at 2 mg/min. Intraspinal Moderate to severe pain Initially, 5 mg epidural inj, Most Read Articles
then 1-2 mg after 1 hr up to a total dose of 10 mg/24 hr, if pain relief is unsatisfactory. Liposomal inj: 10-20
mg. Intrathecal Moderate to severe pain 0.2-1 mg once daily, up to 20 mg/day as necessary. Parenteral
Moderate to severe pain IM/SC: 5-20 mg; IV: 2.5-10 mg via slow inj over 4-5 min or a starting dose of 1-2 1. Apoteker: Trik menangani
mg/hr via continuous infusion (max: 100 mg/day; 4 g/day in cancer patients). Premedication in surgery pasien yang mungkin
IM/SC: Up to 10 mg, given 60-90 min before operation. Rectal Severe pain 10-20 mg 4 hrly. merupakan seorang pecandu
oba...
Dosage Details Intraspinal
Moderate to severe pain 2. Fenomena fenotip digital: Era
Adult: Initially, 5 mg epidural inj; after 1 hr, additional doses of 1-2 mg may be given up to a total dose baru teknologi perawatan
of 10 mg/24 hr if pain relief is unsatisfactory. A dose of 20-30 mg daily may be required in some kesehatan atau peng...
patients. Liposomal inj: 10-20 mg depending on the type of surgery.

Intrathecal 3. Kontroversi eksperimen di

Moderate to severe pain tahun 1932 yang menimbulkan
Adult: 0.2-1 mg once daily or 1-10 mg daily for patients w/ opioid tolerance. Some patients may "gangguan darah"
require a dose of up to 20 mg daily.
4. IMARET: From Disaster Relief
Intravenous to Refugee Heroes
Acute pulmonary oedema
Adult: 5-10 mg via slow inj at 2 mg/min.
Elderly: Half of the usual adult dose.
5. Addressing the Concerns of a
Intravenous Pregnant Patient with Hepatitis
Pain associated with myocardial infarction B
Adult: 5-10 mg at 1-2 mg/min followed by a further 5-10 mg as necessary.
Elderly: Half of the usual adult dose.

Oral
Moderate to severe pain MIMS.com
Adult: 5-20 mg 4 hrly. Extended-release: 5-20 mg 12 hrly. Dosage is dependent on the severity of 110.698 suka
pain.

Parenteral
Moderate to severe pain
Adult: IM/SC: 5-20 mg; 2.5-10 mg via slow IV inj over 4-5 min w/ patient in recumbent position or a Sukai Halaman Daftar
starting dose of 1-2 mg/hr via continuous IV infusion (max: 100 mg/day; 4 g/day in cancer patients).
Doses may be adjusted according to severity of pain and patient's response.
Jadilah orang pertama yang menyukai ini.

Parenteral
Premedication in surgery
Adult: IM/SC: Up to 10 mg, given 60-90 min before operation.

Renal Impairment
Hepatic Impairment
Administration
Incompatibility
Rectal
Severe pain
Adult: 10-20 mg 4 hrly. Dosage may be increased as required.
Dosage may need to be reduced.
Dosage may need to be reduced.
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Aciclovir Na, chlorpromazine HCl, doxorubicin, fluorouracil, furosemide, haloperidol, heparin Na, pethidine
HCl, prochloeperazine edisilate, promethazine HCl, ranitidine HCl, tetracycline, aminophylline, amobarbital
Na, cefepime HCl, chlorothiazide Na, floxacillin Na, gallium nitrate, meperidine HCl, meperidine, Na,
methicillin, Na, minocycline HCl, pentobarbital Na, phenobarbital Na, phenytoin Na, sargramostim, Na
bicarbonate, thiopental Na, Na iodide.

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11/9/2018 Morphine: Indication, Dosage, Side Effect, Precaution | MIMS.com Indonesia
Contraindications Resp depression, obstructive airway disease, delayed gastric emptying, acute abdomen, heart failure
secondary to chronic lung disease, known or suspected paralytic ileus, phaeochromocytoma. Concurrent
admin w/ MAOIs or w/in 2 wk after treatment.
Special Precautions Patient w/ impaired resp function, severe bronchial asthma, convulsive disorders, acute alcoholism,
delirium tremens, raised intracranial pressure, hypotension w/ hypovolaemia, cardiac arrhythmias, severe
cor pulmonale, history of substance abuse, diseases of the biliary tract, pancreatitis, inflammatory bowel
disorders, prostatic hypertrophy, adrenocortical insufficiency, toxic psychoses. Opioid dependent patients.
Renal and hepatic impairment. Pregnancy and lactation.
Adverse Drug Reactions Nausea, vomiting, constipation, abdominal pain, dry mouth, anorexia, taste disturbance, dyspepsia, resp
depression, sedation, dizziness, confusion, insomnia, headache, somnolence, involuntary muscle
contractions, hyperhidrosis, rash, pruritus, asthenic conditions, HTN, bronchospasm, seizures,
amenorrhoea, rhabdomyolysis, nystagmus.
Pregnancy Category (US ROUTE(S) : Parenteral/PO
FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or
embryocidal or other) and there are no controlled studies in women or studies in women and animals are
not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
Patient Counselling May impair ability to drive or operate machinery.
Monitoring Parameters Monitor efficacy of pain control, vital signs, and mental status; signs of drug abuse, addiction, or diversion;
signs or symptoms of hypogonadism or hypoadrenalism.
Overdosage Symptoms: Resp depression, pinpoint pupils, extreme somnolence progressing to stupor and coma,
skeletal muscle flaccidity, cold and clammy skin and sometimes bradycardia and hypotension. Apnoea,
circulatory collapse, and cardiac arrest may occur in severe cases. Management: Re-establish adequate
resp exchange through provision of a patent airway and institution of assisted or controlled ventilation.
Oxygen, IV fluid, vasopressors and other supportive measures may be employed as necessary. Naloxone
may be given as antidote.
Drug Interactions Additive depressant effects w/ other CNS depressants (e.g. sedatives, hypnotics, general anaesth,
phenothiazines, other tranquilisers). May enhance the neuromuscular blocking action of skeletal muscle
relaxants. Reduced analgesic effect w/ mixed agonist/antagonist opioid analgesics (e.g. pentazocine,
nalbuphine, buprenorphine). Increased plasma concentrations w/ cimetidine. May reduce the efficacy of
diuretics by inducing the release of antidiuretic hormone. May delay the absorption of mexiletine. May
antagonise the GI effect of cisapride, domperidone and metoclopramide. May produce hyperpyrexia and
CNS toxicity w/ dopaminergics.
Potentially Fatal: MAOIs intensify the effect of morphine resulting to severe and even fatal events (e.g.
anxiety, confusion, resp depression, sometimes leading to coma).
Food Interaction Alcohol enhances the CNS depressant effect of morphine.
Mechanism of Action Description: Morphine is a phenanthrene derivative which acts mainly on the CNS and smooth muscles. It
binds to opiate receptors in the CNS altering pain perception and response. Analgesia, euphoria and
dependence are thought to be due to its action at the mu-1 receptors while resp depression and inhibition
of intestinal movements are due to action at the mu-2 receptors. Spinal analgesia is mediated by morphine
agonist action at the K receptor.
Onset: Approx 30 min (conventional tab); 5-10 min (IV).
Duration: 4 hr (conventional tab); 8-24 hr (extended-release tab/cap).
Pharmacokinetics:
Absorption: Well absorbed from the GI tract; readily absorbed into blood (IM/SC). Bioavailability: 17-33 %
(oral).
Distribution: Distributed throughout the body mainly in the kidneys, liver, lungs and spleen, w/ lower
concentrations in the brain and muscles. Crosses the blood-brain barrier and placenta; enters breast milk.
Volume of distribution: 1-6 L/kg. Plasma protein binding: Approx 35%.
Metabolism: Metabolised in the liver and gut via glucuronidation to produce morphine-3-glucoronide and
morphine-6-glucoronide; undergoes extensive first-pass metabolism.
Excretion: Via urine (approx 90%) and through the bile into the faeces (10%), mainly as conjugates. Mean
plasma elimination half-life: Approx 2 hr (morphine); 2.4-6.7 hr (morphine-3-glucoronide).
Storage Inj/oral preparations: Store between 15-30°C. Liposomal inj: Store between 2-8°C. Supp: Store below
25°C. Protect from light.
MIMS Class Analgesics (Opioid)

Disclaimer: This information is independently developed by MIMS based on Morphine from various references and is provided for your reference only. Therapeutic
uses and prescribing information may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information.
Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or
misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2018 MIMS. All rights reserved. Powered by MIMS.com

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