Effectiveness of Morphine: It’s Dosage & Side Effects

Intake of morphine is prohibited if you have problems in breathing or severe asthma, intestines or stomach blockage or an obstruction in the bowel known as paralytic ileus.
Morphine can reduce or stop one’s breathing & might be addictive. Wrong usage of this medicine can cause overdose, addiction or death, particularly in any person or child who takes the medicine without prescription.

Opioid is a kind of medicine useful for treating pain. Morphine is one such opioid pain medicine and opioid is occasionally called a narcotic.

Morphine is useful for effective treatment of mild to acute pain. Short-acting formulations are taken according to the pain.

The Extended (ER) release formulation of morphine is for an entire 24-hour day treatment for pain. This morphine form is not useful for regular use.
Intake of morphine at the time of pregnancy can cause serious withdrawal signs, which may be fatal for infant.

If you take morphine along with alcohol the side effects can be fatal or along with other medicines, which slow down your breathing or cause drowsiness.

Stop taking morphine if you have morphine allergic reaction or other narcotic medicines or if you have:

• Problems in breathing or severe asthma; or
• Intestines or stomach blockage.

Never take morphine if you took MAO inhibitor in the last 14 days. Never take morphine in case you have taken an MAO inhibitor during the last 14 days. A drug interaction can occur which is hazardous. MAO inhibitors are linezolid, isocarboxazid, phenelzine, tranylcypromine, selegiline, rasagiline etc…

To ensure morphine is not dangerous for use, inform your physician if you possess:

• Brain tumor, seizures or injury in the head;
• A alcohol or drug addiction;
• Problems in urination;
• Mental illness;
• Kidney or liver disease;
• Lung disease or any kind of breathing problem;
• Issues with pancreas, gallbladder or thyroid;

In case you use valium (alprazolam, klonopin, xanax, lorazepam, versed, restoril, diazepam, ativan, tranxene and others)

Certain medicines can interfere with morphine leading to a severe illness known as serotonin syndrome. Ensure that your physician is well aware if you also intake opioid medication, herbal products, stimulant medicine, medicines for mental illness, depression, severe infections, migraine headaches, Parkinson’s disease or avoidance of vomiting and nausea. Consult your physician in prior before modifications to your dosages.

Your child could become reliant on morphine if you use morphine during pregnancy. This can lead to severe and dangerous withdrawal signs in the child. The babies that are born depending on addictive medicine such as morphine might need therapy for numerous weeks.

Never breast-feed when taking morphine. The medicine morphine can cause breathing trouble, drowsiness and even death to a nursing child via breast milk.

Standard Adult Dosage of Morphine for Pain:

Immediate (IR) release tablets:

Opioid naive:

Beginning morphine dosage: 15-30 mg every 4 hours as necessary orally.

Oral Substance:

Opioid naive:

Beginning morphine dosage: 10-20 mg every 4 hours as necessary orally.

Beginning dosage of opioid naïve individuals have to be given in strengths of 10 mg/5 mL or 20 mg/5 mL. Opioid-tolerant individuals who have been titrated already to a steady regimen of analgesic using lesser morphine strengths might be started on the 100 mg/5 mL (20 mg/mL).

Extended (ER) release oral:

Extended (ER) release products that are different are not bioequivalent. Converting the total daily dosage of one Extended (ER) release product to the other Extended (ER) release product might cause either extreme sedation or insufficient analgesia.

Opioid naive:

Beginning morphine dosage: 30 mg once a day orally.

Opioid tolerant:

Dosage must be consumed 1-2 times every day.

Suppository:

10-20 mg every 4 hours needed rectally.

Subcutaneous/IM:

Beginning morphine dosage: 10 mg every 4 hours as necessary.

Dosage range: 5-20 mg every 4 hours as necessary.

INTRAVENOUS (IV):

-For pain relief & as a preanesthetic:

Beginning dosage: 4-10 mg every 4 hours given slowly over 4 to 5 minutes.

Dosage range: 5-15 mg

Daily dosage range: 12-120 mg

Alternate dosage: 2-10 mg/70 kg of weight.

For Acute (AMI) myocardial infarction:

Beginning morphine dosage: 4-8 mg

Maintenance morphine dosage: 2-8 mg every 4-15 mins as required.

Morphine for serious chronic pain connected with fatal cancer:

-Continuous Intravenous (IV) Injection: Before starting of the injection (in dosages between 0.2-1 mg/mL), a dosage of 15 mg or more of morphine sulfate might be given by Intravenous (IV) push for alleviating pain.

-Intravenous (IV) patient controlled analgesia or subcutaneous patient controlled analgesia:
one to two milligrams of morphine infused half an hour after a standard intravenous (IV) dosage of 5-20 mg.

Epidural:

Beginning dosage: 5 mg in the lumbar region might offer adequate pain relief for a day. If satisfactory relief is not attained in one hour, very cautious administration of augmented dosages of 1-2 mg at intervals adequate for assessing effectiveness might be given.

Max. morphine dosage: 10 mg per 24 hours.

Intrathecal:

-Dose is generally one-tenth of the epidural dose

-Beginning morphine dosage: 0.2-1 mg may offer adequate relief for up a day. Intrathecal injections that are repeated are not recommended.

General Pediatric Dosage of Morphine for Ache/Pain:

-The dosage recommendations that are as follows can be considered only as recommended approaches to what is really a sequence of clinical findings in course of time in managing pain of every patient.

-Efficacy and safety of morphine has not been studied in neonates. Opiate agonists must not be given to premature neonates as the medicines cross the premature blood-brain blockage more freely than in the mature blockage producing inconsistent respiratory related depression. Opiates must be cautiously given and in examined dosages to small children and infants as they might be comparatively more sensitive to opiates based on body weight.

-Subcutaneous: 0.1-0.2 mg/kg as required. Not exceeding 15 mg per morphine dosage.

-IV: 50-100 mcg (0.05-0.1 mg) per kilogram, given very gradually. Not above 10 mg/dosage.

Standard Pediatric Dosage of Morphine for Neonatal Abstinence Syndrome:

Younger than 1 month:

Dosage Based on Weight: 0.04 mg/kg every 3-4 hours orally.

Max. morphine dosage: 0.2 mg/kg

Dosing Based On Symptom (NAS (Neonatal Abstinence Syndrome) Score):

– Neonatal Abstinence Syndrome Score 9-12; Dosage: 0.04 mg once in four hours orally

– Neonatal Abstinence Syndrome Score 13-16; Dosage: 0.08 mg once in four hours orally

– Neonatal Abstinence Syndrome Score 17-20; Dosage: 0.12 mg once in four hours orally

– Neonatal Abstinence Syndrome Score 21-24; Dosage: 0.16 mg once in four hours orally

– Neonatal Abstinence Syndrome Score above 25; Dosage: 0.2 mg once four hours orally.

Weaning: After 2 days of Clinical Stability

-Decrease the morphine dosage by 10 percent every 24-48 hours

-Stop morphine therapy when dosage is 0.15 mg/kg/day.

-Roughly around 60 percent to 80 percent of neonates with Neonatal Abstinence Syndrome Score might not respond to nonpharmacologic morphine therapy and will need medicines.

-Oral morphine is being used widely for this purpose as the most favorable pharmacologic approach go on to be studied.

-Pharmacologic therapy is commenced/titrated/accustomed as a part of the overall strategy that is based on the neonatal abstinence scores (example: Finnegan scores).

-The Finnegan scoring system is standardized for usage in term babies; its usage in older or preterm babies must be considered not standardized; in addition, considerable intra-observer variability has been recognized.

You need to get urgent medical help in case you have any signs or symptoms of morphine allergy like breathing difficulty, inflammation in your lips, throat, face or tongue.

Morphine can reduce your breathing rate like other opioid medicines. Very weak breathing may be fatal. Your care-taker must ask for urgent medical attention in case of blue colored lips or if you find difficulty in waking up or if your breathing is slow with lengthy pauses.

Contact your physician immediately if you have the following severe side effects of morphine:

• Pain in the chest, pounding or faster heartbeats;
• Sighing, slower heart rate or low breathing;
• Excessive drowsiness, vomiting feeling; or
• Lower levels of cortisol – appetite loss, vomiting, nausea, weakness or deteriorating tiredness or dizziness.

Get medical attention instantly if you have symptoms or signs of serotonin syndrome like hallucinations, fever, agitation, shivering, sweating, faster heart rate, stiffness of muscle, nausea, twitching, diarrhea, vomiting or loss of coordination.

Morphine is more probable in causing breathing problems in elders and people who are malnourished, severely ailing or otherwise exhausted.

Using opioid medicine for longer period might affect fertility in women or men. It is unclear if the effect of morphine on fertility is permanent or not.

General side effects of morphine may include the following:

• Dizziness, drowsiness;
• Stomach pain, vomiting, constipation, nausea;
• Tiredness, headache are also side effects of morphine;
• Anxiety; or
• Slight itching.