Morphine sulphate and morphine tartrate

Morphine sulphate and morphine tartrate

[15mg vial $1.03]

ADMINISTRATION ROUTES:

• IV

ALTERNATIVE NAMES:

• RA morph (morphine hydrochloride), LA morph, m-Eslon, Sevredol

ICU INDICATIONS:

1. analgesia
2. sedation

PRESENTATION AND ADMINISTRATION:

• IV:
  Morphine sulphate 10mg/1ml and 30mg/1ml ampoules; also, comes in 50mg in 50ml prefilled syringes. Also available, morphine tartrate 120mg in 1.5ml (used primary to make up morphine PCAs in double strength – i.e. 120mg in 60ml)
  For direct injection, the usual method is to dilute 10mg into a total of 10ml of compatible IV fluid
  For infusion, use prefilled syringes or dilute with compatible IV fluid to a dilution of 1mg/ ml Compatible in the following IV fluids:
  Normal saline, 5%dextrose, Hartmanns, Glucose and sodium chloride
  Store at room temperature. Protect from light. Store in controlled drug safe.
• PO:
  Tablets:
  Sevredol 10mg tablets (blue), Sevredol 20mg tablets (pink)
  Sustained Release Tablets:
  LA Morph 10mg tablets (buff), LA Morph 30mg tablets (violet), LA Morph 60mg tablets (orange), LA Morph 100mg tablets (grey)
  Sustained Release Capsules:
  M-Eslon 10mg (yellow), M-Eslon 30mg (pink), M-Eslon 60mg (orange), M-Eslon 100mg (white)

DOSAGE:

• PO:
  Initially 5-20 mg every 4 hours of sevredol. Sustained release formulations are administered 12 hourly
• IV:
  Analgesia: usually 1-5mg PRN
  Infusion: 0-20mg/hr PCA: usually 1mg with 5 minute lock-out and maximum of 12mg/hr

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose in renal impairment [GFR (ml/min)]
  <10: use small doses (e.g. 1mg)
  10-20: use small doses (e.g. 2mg)
  >20-50: 75% of normal
• Dose in renal replacement therapy
  CAPD: use small doses (e.g. 1mg)
  HD: use small doses (e.g. 1mg)
  CVVHD: use small doses (e.g. 2mg)

  Note: usually fentanyl is used in preference to morphine where there is significant renal impairment

DOSAGE IN PAEDIATRICS:

• IM
  0.1-0.2mg/kg
  
• IV
  0.05-0.1mg/kg by slow incremental injection over 5 to 15 minutes. If ventilated, 0.1-0.2mg/kg/dose.
• IV infusion
  1mg/kg in 50ml 5% dextrose at 0-4ml/hr (0-80mcg/kg/hr)
• PCA
  20mcg/kg boluses (1ml of 1mg/kg in 50ml) with 5 minute lock-out time

CLINICAL PHARMACOLOGY:

• Morphine is a pure opiate agonist

CONTRAINDICATIONS:

1. hypersensitivity to morphine

WARNINGS

• Impaired Respiration
  Respiratory depression is the chief hazard of all morphine preparations. Respiratory depression occurs most frequently in the elderly and debilitated patients as well as in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Morphine should be used with extreme caution in patients with chronic obstructive pulmonary disease or cor pulmonale, and in patients having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression. In such patients, even usual therapeutic doses of morphine may decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea.
• Hypotensive Effect
  Morphine sulphate controlled-release tablets, like all opioid analgesics, may cause severe hypotension in an individual whose ability to maintain his blood pressure has already been compromised by a depleted blood volume, or a concurrent administration of drugs that lower blood pressure.
• Anaphylaxis
  Although extremely rare, cases of anaphylaxis have been reported.

PRECAUTIONS

• General:
  Morphine may aggravate pre-existing convulsions in patients with convulsive disorders.
• Laboratory Tests: No tests in addition to routine ICU tests are indicated
• Drug/Laboratory Test Interactions: None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

• The concomitant use of other central nervous system depressants including sedatives or hypnotics, general anaesthetics, phenothiazines, tranquilizers, and alcohol may produce additive depressant effects. Respiratory depression, hypotension, and profound sedation or coma may occur.

ADVERSE REACTIONS

• Central Nervous System:
  Weakness, headache, agitation, tremor, uncoordinated muscle movements, seizure, alterations of mood (nervousness, apprehension, depression, floating feelings), dreams, muscle rigidity, transient hallucinations and disorientation, visual disturbances, insomnia.
• Respiratory:
  Respiratory depression, apnoea, respiratory arrest
• Gastrointestinal:
  Dry mouth, biliary tract spasm, laryngospasm, anorexia, diarrhoea, cramps, taste alteration, constipation, ileus, intestinal obstruction, increases in hepatic enzymes.
• Cardiovascular:
  Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension.
• Genitourinary:
  Urine retention or hesitance, reduced libido and/or potency.
• Dermatologic:
  Pruritus, urticaria, other skin rashes, edema, diaphoresis.