Morphine

Complete Guide with FAQs

Introduction

• Morphine is a potent opioid analgesic used to relieve moderate to severe pain.
• Derived from the opium poppy, it is considered the gold standard for managing acute and chronic pain, particularly in cancer and palliative care settings.
• Requires careful dosing and monitoring due to its potential for addiction, tolerance, and respiratory depression.

Class and Mechanism of Action

• Drug Class: Opioid analgesic.
• Mechanism:
  • Binds to mu-opioid receptors in the brain and spinal cord.
  • Inhibits pain signals and alters the perception of pain.
  • Produces sedation and euphoria as secondary effects.

Indications

• Acute Pain: Post-operative pain, trauma, or severe injury.
• Chronic Pain: Cancer-related pain, palliative care, or end-of-life pain management.
• Other Uses:
  • Relief of dyspnea in heart failure or palliative care.
  • Pre-anesthetic medication in some cases.

Dosage and Administration

• Formulations: Oral tablets, capsules, liquid solution, injectable forms, and suppositories.

Typical Dosage

• Immediate-Release Tablets: 10–30 mg every 4 hours as needed.
• Extended-Release Tablets: 15–200 mg every 8–12 hours for chronic pain.
• Injectable: 2.5–15 mg every 4 hours as needed for acute pain.

Administration Guidelines

• Start with the lowest effective dose, especially in opioid-naïve patients.
• For extended-release forms, do not crush or chew tablets.
• Rotate administration sites for injections to avoid tissue damage.

Forms, Brand Names, Manufacturers, and Prices

• Brand Names: MS Contin (Purdue Pharma), Kadian (Allergan), Morphabond.
• Price: ~$20–$100 per pack (varies by region and formulation).
• Availability: Prescription-only in most countries due to potential for misuse.

Contraindications and Precautions

• Contraindications:
  • Severe respiratory depression or acute asthma.
  • Hypersensitivity to morphine or opioids.
  • Paralytic ileus.
• Precautions:
  • Use cautiously in patients with head injuries (may increase intracranial pressure).
  • Avoid abrupt discontinuation to prevent withdrawal symptoms.
  • Monitor for signs of tolerance and dependence.

Side Effects

Common Side Effects

• Nausea, vomiting.
• Constipation.
• Drowsiness, dizziness.

Less Common Side Effects

• Dry mouth.
• Sweating, flushing.
• Mild confusion.

Rare but Serious Side Effects

• Respiratory depression (most dangerous in overdose).
• Addiction and dependence.
• Hypotension or bradycardia.

Drug Interactions

• CNS Depressants: Increased risk of sedation and respiratory depression (e.g., benzodiazepines, alcohol).
• Anticholinergics: Worsens constipation and urinary retention.
• Monoamine Oxidase Inhibitors (MAOIs): Risk of severe reactions, including respiratory depression.
• Other Opioids: Combined use increases overdose risk.

Monitoring Parameters

• Pain relief and functional improvement.
• Respiratory rate and oxygen saturation to detect respiratory depression.
• Signs of dependence or misuse.
• Bowel function to manage constipation.

Patient Counseling Points

• Take morphine as prescribed; do not exceed the recommended dose.
• Avoid alcohol and other sedatives while using morphine.
• Use stool softeners or laxatives to prevent constipation.
• Report severe drowsiness, confusion, or difficulty breathing immediately.
• Dispose of unused morphine safely to prevent misuse.

Use in Children

• Used under strict medical supervision for severe pain.
• Doses adjusted based on weight and age.

Use in Pregnancy

• Avoid unless benefits outweigh risks; prolonged use may lead to neonatal withdrawal syndrome.

Use in Elderly

• Start with lower doses due to increased sensitivity to side effects like sedation and respiratory depression.

FAQs About Morphine

Q1: What is morphine used for?

• Morphine is used for managing moderate to severe pain, particularly in cancer and post-operative care.

Q2: Is morphine addictive?

• Yes, morphine has a high potential for addiction, especially with prolonged or unsupervised use.

Q3: Can morphine cause respiratory depression?

• Yes, respiratory depression is a serious side effect, particularly in overdoses or opioid-naïve patients.

Q4: How does morphine compare to other opioids?

• Morphine is often used as the reference opioid due to its well-understood efficacy and side effects.

Q5: Can I drive while taking morphine?

• Avoid driving or operating heavy machinery, as morphine can impair alertness and coordination.

Q6: How is morphine taken?

• Morphine can be taken orally, injected, or as a suppository, depending on the condition and severity of pain.

Q7: Can morphine cause constipation?

• Yes, constipation is a very common side effect; use stool softeners or laxatives as needed.

Q8: Is morphine safe for long-term use?

• Long-term use requires careful monitoring to manage risks of tolerance, dependence, and side effects.

Q9: What should I do if I miss a dose of morphine?

• Take the missed dose as soon as you remember unless it’s close to the next scheduled dose. Do not double up.

Q10: Can morphine be combined with other painkillers?

• Yes, it can be combined with non-opioid analgesics like acetaminophen for enhanced pain relief.

Q11: Are there natural alternatives to morphine?

• Natural opioids like codeine or non-opioid alternatives (e.g., NSAIDs) may be considered for less severe pain.

Q12: How long does morphine take to work?

• Immediate-release forms begin working within 30 minutes; extended-release forms take longer but provide sustained relief.

Q13: Can morphine be stopped abruptly?

• No, stopping morphine suddenly can cause withdrawal symptoms. Always taper under medical supervision.

Q14: What are the signs of morphine overdose?

• Symptoms include slow breathing, extreme drowsiness, cold/clammy skin, and loss of consciousness. Seek emergency care immediately.

Q15: How should unused morphine be disposed of?

• Use drug take-back programs or follow local guidelines for safe disposal to prevent misuse.

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