How much morphine to plug

Oral Solution Carefully check dose prior to dispensing medication as many concentrations of morphine oral solution are available. Always use an appropriately calibrated measuring device e. Dispense in unit-dose packaging. Protect from light and excessive heat. The product may deposit sediment if exposed to low temperatures. Filter if necessary. Place poison labels on all containers of opium tincture as well as label the strength of morphine per mL.

Include a warning regarding improper substitution of camphorated opium tincture 0. Extemporaneous 0. Transfer to an appropriate-sized plastic amber bottle. Measure 40 mL of Sterile Water for Irrigation in a syringe or graduated cylinder. Transfer to the plastic amber bottle containing morphine. Shake to mix. Storage: The solution is stable for 60 days when stored in a light protected container at room temperature 20 to 25 degrees C.

Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Intermittent IV Injection Inject directly into a vein or into the tubing of a freely flowing IV solution over 4 to 5 minutes.

Rapid IV injection of morphine may result in an increased frequency of adverse effects. Common concentrations range from 0. Administer using a controlled-infusion device. Adjust dose and rate based on patient response.

Consult the patient-controlled infusion device operator's manual for directions on administering the drug at the desired rate of infusion. Inject into a large muscle mass e. Inject subcutaneously taking care not to inject intradermally. Adjust rate based on patient response and tolerance. Use ONLY preservative-free injectable solutions. Intrathecal administration should only be used by specially trained healthcare professionals.

Intrathecal dose is approximately one-tenth of the epidural dose. If the product is supplied in a glass vial, filter the drug through a 5 micron or smaller microfilter. Monitor patient in a fully equipped and staffed environment for at least 24 hours after each dose.

Both early and late respiratory depression has occurred more frequently after intrathecal administration than epidural administration. For highly concentrated injections, an implantable controlled-microinfusion device is used. Monitor patients in a fully equipped and staffed environment for several days after implantation of the device.

If dilution of the injection is necessary, 0. Filling of the infusion device reservoir should only be done by fully trained and qualified healthcare professionals. Strict aseptic technique must be used. Ensure proper placement of the needle when filling the reservoir to avoid accidental overdosage.

Epidural administration should only be used by specially trained healthcare professionals. May be given as intermittent bolus, continuous infusion, or as patient-controlled epidural analgesia.

Storage: For single use only. Protect from light; discard any unused portion. Instruct patient or caregiver on proper use of suppository. Moisten the suppository with water prior to insertion. If suppository is too soft because of storage in a warm place, chill in the refrigerator for 30 minutes or run cold water over it before removing the wrapper.

Generic: - Discard product if it contains particulate matter, is cloudy, or discolored - Discard unused portion. Do not store for later use. Although true opiate agonist hypersensitivity is rare, use is contraindicated in patients with a history of hypersensitivity reactions to morphine.

Further, do not use other opioid agonists of the phenanthrene subclass including oxycodone, codeine, and hydromorphone in such patients. It may be possible to treat these patients with an opioid agonist from the phenylpiperidine subclass meperidine or fentanyl or the diphenylheptane subclass methadone.

Do not abruptly discontinue morphine in patients who may be physically dependent on opioids. Abrupt discontinuation of morphine in physically opioid-dependent patients has resulted in serious withdrawal symptoms, uncontrolled pain, suicide, and drug-seeking behavior.

Consider the opioid dose, duration of therapy, type of pain being treated, and physical and psychological attributes of the patient when decreasing the opioid dose or discontinuing therapy.

Ensure ongoing care of the physically opioid-dependent patient, including a multimodal approach to pain management, and devise an appropriate tapering schedule and follow-up plan so that patient and provider goals are clear and realistic. When discontinuing therapy due to suspected substance abuse, evaluate and treat the patient or refer for evaluation and treatment of the substance abuse disorder.

Patients who have been taking opioids for shorter periods of time may tolerate a more rapid taper. Reassess patients frequently to manage pain and withdrawal symptoms, if they emerge. Common withdrawal symptoms include restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills, myalgia, and mydriasis. Irritability, anxiety, backache, joint pain, weakness, abdominal cramps, insomnia, nausea, anorexia, vomiting, diarrhea, or increased blood pressure, respiratory rate, or heart rate may also occur.

If withdrawal symptoms arise, pause the taper or increase the opioid dose to the previous dose, then proceed with a slower taper. Monitor patients for changes in mood, emergence of suicidal thoughts, or use of other substances. Avoid use of partial agonists e.

The severity of the withdrawal syndrome produced will depend on the degree of physical dependence and on the administered dose of the opioid antagonist. Morphine tablets, capsules, oral solution, and solution for injection are contraindicated in patients with known or suspected GI obstruction, including paralytic ileus.

Morphine suspension for injection is contraindicated in patients with paralytic ileus. Due to the effects of opioid agonists on the gastrointestinal tract, all forms of morphine should be used cautiously in patients with GI disease including GI obstruction, ulcerative colitis, GI bleeding, or pre-existing constipation. Instruct patients not to pre-soak, lick, or otherwise wet Arymo extended-release tablets prior to placing in the mouth; tablets may become sticky leading to difficulty in swallowing, choking, gagging, regurgitation, and tablets stuck in the throat.

Patients should take 1 tablet at a time with enough water to ensure complete swallowing. Tablet stickiness and swelling may predispose patients to intestinal obstruction and diverticulitis exacerbation. Patients with underlying GI disorders such as esophageal cancer or colon cancer with a small gastrointestinal lumen are at a greater risk of developing these complications.

Consider use of an alternative analgesic in patients who have difficulty swallowing and patients at risk for underlying GI disorders resulting in small gastrointestinal lumen. Patients with ulcerative colitis UC or other inflammatory bowel disease may be more sensitive to the constipating effects of morphine. Opioid agonists may obscure the diagnosis or clinical course in patients with an acute abdomen; morphine rectal suppositories are contraindicated for use in patients with known or suspected acute abdomen or surgical anastomosis.

Although opioid agonists are not desirable for use in patients with diarrhea secondary to poisoning or infectious diarrhea, antimotility agents have been used successfully in these patients.

If possible, opioid agonists should not be given until the toxic substance has been eliminated. Morphine and other opioid agonists increase the tone and pressure in the biliary tract causing spasms especially in the sphincter of Oddi. Morphine should be used cautiously in patients with biliary tract disease or in patients undergoing biliary tract surgery; morphine suppositories are contraindicated for use after biliary tract surgery.

The biliary effects of morphine may result in increased plasma amylase and lipase concentrations of 2 to 15 times the normal values. Morphine should be used with extreme caution in patients with head trauma, a brain tumor, increased intracranial pressure ICP , convulsive disorders such as seizure disorders , or severe CNS depression; the use of morphine suppositories is specifically contraindicated in each of these conditions.

Additionally, morphine suspension for injection DepoDur is contraindicated in patients with head trauma or increased intracranial pressure ICP. Opioid agonists can compromise the evaluation of neurologic parameters. Rapid administration of high-dose opioid agonists may transiently elevate ICP and reduce cerebral perfusion pressures.

These events are associated with opioid-induced lowering of mean arterial pressure, which stimulates a regulatory response to increase cerebral blood flow leading to increased ICP.

Opioid agonist-induced respiratory depression can produce cerebral hypoxia and raise cerebrospinal fluid CSF pressure. Monitor patients for signs of sedation and depressed respirations. Use caution in patients with a pre-existing seizure disorder or cerebral arteriosclerosis. Morphine can precipitate seizures, especially at high doses; monitor patients with a history of seizure disorders for worsened seizure control during therapy.

Morphine and other opioid agonists produce cholinergic side effects by stimulating medullary vagal nuclei.

Bradycardia and induction of histamine release causing peripheral vasodilation may result. As such, the use of morphine injectable solution Astramorph is contraindicated in patients whose ability to maintain blood pressure has already been compromised by hypovolemia.

Extreme caution should be exercised when using other dosage forms in patients with hypovolemia or in those taking phenothiazines or general anesthetics, which may alter the capacity to sustain adequate pressures. Morphine suspension injection DepoDur is contraindicated in patients with circulatory shock; use of other morphine formulations should also be avoided. Morphine suppositories are contraindicated in patients with cardiac arrhythmias or heart failure secondary to chronic lung disease, as bradycardia and vasodilation may aggravate these conditions.

Use morphine with caution in patients with atrial flutter, atrial fibrillation, or other supraventricular tachycardias, as vagolytic action may produce significant increases in ventricular response rate. Morphine should also be used cautiously in patients with cardiac disease, angina, or hypotension.

Opioid agonists can induce vasovagal syncope or orthostatic hypotension; use caution in patients with pre-existing orthostatic hypotension. Morphine and other opioid agonists can cause urinary retention and oliguria, due to increasing the tension of the detrusor muscle. Patients more prone to these effects include those with bladder obstruction, prostatic hypertrophy, urethral stricture, pelvic malignancy, or renal disease. Drug accumulation or prolonged duration of action can occur in patients with renal impairment or hepatic disease.

In acute situations, patients require close monitoring to avoid excessive toxicity. Patients with chronic liver or renal disease may require less frequent dosing intervals. Urinary retention may occur with single epidural or intrathecal morphine administration, or during the first several days of hospitalization for the initiation of continuous intrathecal or epidural morphine therapy. Urinary retention may persist for 10 to 20 hours and occurs more frequently in male patients than females.

Opioid agonists may be used in children with moderate to severe pain. However, certain morphine dosage formulations or administration methods may not be appropriate for children; children also require close monitoring during opioid use. Neonates and infants younger than 6 months of age have highly variable clearance of opioid agonists. Therefore, infants younger than 6 months of age may be given morphine but must be closely monitored for apnea until 24 hours after their last dose.

Clinical practice guidelines suggest close monitoring of children up to 1 year of age. The safety and efficacy of epidural or intrathecal use of morphine in children, including the DepoDur product, have not been established.

The safety and efficacy of extended-release morphine formulations have not been established in pediatric patients younger than 18 years. Use morphine with caution in geriatric or debilitated patients. Geriatric or debilitated patients are more susceptible to adverse reactions, especially sedation and respiratory depression, probably as a result of the altered distribution of the drug or decreased elimination.

Initial doses may need to be reduced, and doses should be carefully titrated, taking into account analgesic effects, adverse reactions, and concomitant conditions and drugs that may increase CNS depression and depress respiration. If an opiate must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures and implement strategies to reduce fall risk.

In patients receiving palliative care or hospice, the balance of benefits and harms of medication management may differ from those of the general population of older adults. OBRA cautions that opioids may cause constipation, nausea, vomiting, sedation, lethargy, weakness, confusion, dysphoria, physical and psychological dependency, hallucinations, and unintended respiratory depression, especially in individuals with compromised pulmonary function. These adverse effects can lead to other consequences such as falls.

The initiation of longer-acting opioids is not recommended unless shorter-acting opioids have been unsuccessful, or titration of shorter-acting doses has established a clear daily dose of opioid analgesic that can be provided by using a long-acting form. Any patient receiving an opioid agonist should be warned about the possibility of sedation and to use caution when driving or operating machinery.

Use of morphine oral dosage forms, suppositories, and solution for injection is contraindicated in patients who are receiving or have received MAOI therapy within the past 14 days. Manufacturers of other morphine dosage forms do not recommend the concurrent use of MAOIs or morphine use within 14 days of stopping such treatment.

Additive CNS depression, drowsiness, dizziness, or hypotension may occur. Use morphine with caution in patients with adrenal insufficiency i. Such patients may be at increased risk of adverse events. Opioids inhibit the secretion of adrenocorticotropic hormone ACTH , cortisol, and luteinizing hormone LH ; however, the thyroid stimulating hormone may be either stimulated or inhibited by opioids.

Rarely, adrenal insufficiency has been reported in association with opioid use. Patients should seek immediate medical attention if they experience symptoms such as nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, or hypotension. If adrenocortical insufficiency is suspected, confirm with diagnostic testing as soon as possible. If diagnosed, the patient should be treated with physiologic replacement doses of corticosteroids, and if appropriate, weaned off of opioid therapy.

If the opioid can be discontinued, a follow-up assessment of adrenal function should be performed to determine if corticosteroid treatment can be discontinued. Other opioids may be tried; some cases reported use of a different opioid with no recurrence of adrenocortical insufficiency. It is unclear which, if any, opioids are more likely to cause adrenocortical insufficiency. In addition, chronic opioid use may lead to symptoms of hypogonadism, resulting from changes in the hypothalamic-pituitary-gonadal axis.

Monitor patients for symptoms of opioid-induced endocrinopathy, particularly those receiving a daily dose equivalent to mg or more of morphine. Patients presenting with signs or symptoms of androgen deficiency should undergo laboratory evaluation.

Use morphine with caution in breast-feeding mothers because it can pass into breast milk. The milk to plasma AUC ratio of morphine is approximately 2.

In studies of epidural morphine given postcesarean section, morphine passage into colostrum and breast milk is minimal, while higher concentrations are found with intravenous or oral administration. Morphine passage into breast milk was assessed in a study of 5 women who were given a 7. Average IV morphine consumption in the first 48 hours was approximately mg. Average morphine consumption across the entire study period 96 hours was approximately mg IV and oral.

Previous American Academy of Pediatrics recommendations considered morphine usually compatible with breast-feeding, particularly in short-term post-partum use, due to a lack of data regarding symptoms in exposed infants. However, opioids may cause serious adverse effects in the infant, including drowsiness, CNS depression, and death. If morphine is used during breast-feeding, short durations and low doses are recommended with close infant monitoring.

If morphine is used long-term, the importance of continuing breast-feeding should be judged against the potential risk of adverse drug effects in the infant.

Withdrawal symptoms may occur in infants whose mothers discontinue chronic opioid therapy. Advise the mother to report any excessive sleepiness, breathing difficulties, or difficulties breast-feeding to their health care provider immediately. Other alternative analgesics considered to be usually compatible with breast-feeding include ibuprofen, acetaminophen, and fentanyl.

Chronic opioid use may influence the hypothalamic-pituitary-gonadal axis, leading to hormonal changes that may manifest as hypogonadism gonadal suppression and pose a reproductive risk. Although the exact causal role of opioids in the clinical manifestations of hypogonadism is unknown, patients could experience libido decrease, impotence, amenorrhea, or infertility.

It is not known whether the effects on fertility are reversible. Monitor patients for symptoms of opioid-induced endocrinopathy. PDR Search. Required field. Your Name Your name is required. Recipient's Email Separate multiple email address with a comma Please enter valid email address Recipient's email is required.

Thank you. Your email has been sent. Jump to Section. Asthma, chronic obstructive pulmonary disease COPD , coadministration with other CNS depressants, coma, cor pulmonale, emphysema, hypoxemia, obesity, pulmonary disease, respiratory depression, respiratory insufficiency, scoliosis, sleep apnea, status asthmaticus. Anticoagulant therapy, coagulopathy, infection, intramuscular administration, intrathecal administration, intravenous administration, requires a specialized care setting, requires an experienced clinician, subcutaneous administration.

Accidental exposure, opioid-naive patients, potential for overdose or poisoning. Labor, neonatal opioid withdrawal syndrome, obstetric delivery, pregnancy. NOTE: FDA-approved labeling defines adult opioid-tolerant patients as those who take the following per day for a minimum of 1 week: oral morphine 60 mg or more; oral oxycodone 30 mg or more; oral hydromorphone 8 mg or more; oral oxymorphone 25 mg or more; 60 mg oral hydrocodone or more; transdermal fentanyl 25 mcg or more per hour; or another opioid at an equivalent dose.

For the management of chronic severe pain in patients who require daily, around-the-clock, long-term opioid treatment. NOTE: Reserve extended-release morphine for when alternative options e. Discontinue all other around-the-clock opioids upon initiation. NOTE: Do not use the following morphine products in opioid-naive patients: 60 mg, 90 mg, or mg biphasic-release capsules Avinza ; mg, mg, mg, or mg extended-release capsules Kadian ; mg or mg controlled-release tablets MS Contin ; mg extended-release tablets Morphabond.

In this population, use could result in fatal respiratory depression. Use of a single dose of more than 60 mg, or a total daily dose more than mg, should be limited to opioid-tolerant patients. NOTE: FDA-approved labeling defines adult opioid-tolerant patients as those who take the following per day for a minimum of 1 week: oral morphine 60 mg or more; oral oxycodone 30 mg or more; oral hydromorphone 8 mg or more; oral oxymorphone 25 mg or more; oral hydrocodone 60 mg or more; transdermal fentanyl 25 mcg or more per hour; or another opioid at an equivalent dose.

Oral dosage [extended-release tablets MS Contin ] in pediatric patients. Oral dosage immediate-release tablets. Children and Adolescents weighing 50 kg or more. Children and Adolescents 2 to 17 years. Intermittent Intravenous, Intramuscular, or Subcutaneous dosage. Infants, Children, and Adolescents 6 months to 17 years. Infants, Children, and Adolescents. Children 7 years and older and Adolescents.

Epidural dosage morphine sulfate injection. Intrathecal dosage morphine sulfate injection. For the treatment of noninfectious diarrhea. Serious patient harm may occur with incorrect product selection. Adolescents and Children. Intravenous dosage. NOTE: Morphine should be administered as an inducing agent only by those trained in anesthesia. Adolescents, Children, and Infants. Oral dosage extended-release formulations. Oral dosage extended-release. Oral Administration.

Oral Solid Formulations. Oral Liquid Formulations. Extemporaneous Compounding-Oral. Injectable Administration. Intravenous Administration. Intramuscular Administration. Subcutaneous Administration. Intrathecal Administration. Other Injectable Administration. Rectal Administration. Alcoholism, depression, opioid overdose, opioid use disorder, substance abuse. Acute abdomen, constipation, diarrhea, GI bleeding, GI disease, GI obstruction, ileus, inflammatory bowel disease, ulcerative colitis.

Arteriosclerosis, brain tumor, CNS depression, head trauma, increased intracranial pressure, seizure disorder, seizures, status epilepticus, strychnine toxicity. Angina, atrial fibrillation, atrial flutter, cardiac arrhythmias, cardiac disease, heart failure, hypotension, hypovolemia, orthostatic hypotension, shock. Bladder obstruction, hepatic disease, oliguria, prostatic hypertrophy, renal disease, renal impairment, urethral stricture, urinary retention.

Morphine may increase the risk that you will experience breathing problems or other serious or life-threatening breathing problems, sedation, or coma if used along with certain medications. Tell your doctor if you are taking or plan to take any of the following medications: benzodiazepines such as alprazolam Xanax , diazepam Diastat, Valium , estazolam, flurazepam, lorazepam Ativan , and triazolam Halcion ; medications for mental illness, nausea, or pain; muscle relaxants; sedatives; sleeping pills; or tranquilizers.

Your doctor may need to change the dosages of your medications and will monitor you carefully. If you use morphine rectal with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness.

Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own. Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with morphine rectal increases the risk that you will experience these serious, life-threatening side effects.

Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment. Morphine rectal is used to relieve moderate to severe pain. Morphine is in a class of medications called opiate narcotic analgesics.

It works by changing the way the body senses pain. Morphine rectal comes as a suppository to insert in the rectum. It is usually inserted every 4 hours. Use rectal morphine at around the same times every day.

Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

Your doctor may adjust your dose of morphine during your treatment to control your pain as well as possible. If you feel that your pain is not controlled, call your doctor. Do not change the dose of your medication without talking to your doctor.

Do not stop using morphine without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop using morphine, you may experience withdrawal symptoms such as anxiety; sweating; difficulty falling asleep or staying asleep; chills; shaking of a part of your body that you cannot control; nausea; diarrhea; runny nose, sneezing or coughing; hair on your skin standing on end; or hallucinating seeing things or hearing voices that do not exist.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. Insert the missed dose as soon as you remember it.

However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not insert a double dose to make up for a missed one. Morphine may cause other side effects. Call your doctor if you have any unusual problems while using this medication. Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture not in the bathroom. It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily.

To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them.

However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program.

In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at While using morphine, you should talk to your doctor about having a rescue medication called naloxone readily available e.

Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. Your doctor may also prescribe you naloxone if you are living in a household where there are small children or someone who has abused street or prescription drugs. You should make sure that you and your family members, caregivers, or the people who spend time with you know how to recognize an overdose, how to use naloxone, and what to do until emergency medical help arrives.

Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions. If symptoms of an overdose occur, a friend or family member should give the first dose of naloxone, call immediately, and stay with you and watch you closely until emergency medical help arrives.

Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Keep all appointments with your doctor and laboratory. Your doctor may order certain lab tests to check your body's response to morphine.

Before having any laboratory test especially those that involve methylene blue , tell your doctor and the laboratory personnel that you are using morphine rectal. This prescription is not refillable.