II. Dosing: Analgesia
- Child
- Dose: 0.025-0.1 mg/kg IV/IM/SQ q3-4h
- Adult
- Intravenous: 1-4 mg (0.1-0.2 mg/kg)
- Typical dose 4 mg (2 mg in the elderly)
- Other routes: 10-20 mg (up to 30 mg) every 4 hours IM, PO or PR
- Morphine immediate release 15 mg PO is equivalent to 5 mg IV
- Morphine immediate release is available in 15 mg and 30 mg tablets
- Morphine is less euphoric than Oxycodone and Hydrocodone
- Intravenous: 1-4 mg (0.1-0.2 mg/kg)
III. Dosing: Procedural Sedation and Analgesia
- IV/IM/SC: 0.05 to 0.2 mg/kg every 2-4 hours up to 15 mg (typically given in 2-4 mg increments)
- Intramuscular onset of activity may be delayed as long as 30 minutes
IV. Pharmacokinetics
- Onset 1 to 2 minutes
- Peaks 3 to 5 minutes
- Duration 1 to 2 hours
V. Metabolism
- Avoid in severe liver disease or Cirrhosis (increased Bioavailability and decreased clearance)
- Avoid in Renal Failure (accumulation of renally cleared metabolites)
VI. Advantages
- Compared with other Hydromorphone or Oxycodone, Morphine has less simulation of euphoria (less abuse risk)
VII. Adverse Effects
- See Opioid Adverse Effect
- Adverse effects (Pruritus, Nausea, Hypotension) occur in 10% of patients given IV Morphine
- Histamine release (more than with other Opioid Analgesics)
- Pruritus and/or rash are common
- Typically not Allergic Reaction
-
Nausea or Vomiting
- Consider pretreatment with Antiemetic (e.g. Ondansetron)
-
Hypotension
- Consider pretreatment bolus of crystalloid (500 cc or 10-20 cc/kg NS)
- Oversedation
- Reversal: Naloxone
VIII. References
- Acker, Koval and Leeper (2017) Crit Dec Emerg Med 31(4): 3-13
- Velasco and Kiel (2023) Crit Dec Emerg Med 37(1): 4-9
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Related Studies
| morphine sulfate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MORPHINE SULFATE ER 10 MG CAP | Generic | $2.38 each |
| MORPHINE SULFATE ER 20 MG CAP | Generic | $3.29 each |
| MORPHINE SULFATE ER 30 MG CAP | Generic | $2.90 each |
| MORPHINE SULFATE IR 15 MG TAB | Generic | $0.24 each |
| MORPHINE SULFATE IR 30 MG TAB | Generic | $0.32 each |
| morphine (on 10/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MORPHINE SULF 10 MG/5 ML SOLN | Generic | $0.09 per ml |
| MORPHINE SULF 100 MG/5 ML CONC | Generic | $0.43 per ml |
| MORPHINE SULF ER 100 MG TABLET | Generic | $0.81 each |
| MORPHINE SULF ER 15 MG TABLET | Generic | $0.20 each |
| MORPHINE SULF ER 30 MG TABLET | Generic | $0.31 each |
| MORPHINE SULF ER 60 MG TABLET | Generic | $0.54 each |