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What is Morphine?

A morphine-based combination is used to treat moderate to severe pain when around-the-clock pain relief is needed for a long period of time. This medicine should not be used to treat pain that you only have once in a while or pain that can be relieved with non-narcotic medication. Morphine is a narcotic analgesic. It acts on the central nervous system (CNS) to relieve pain.

The Morphine Drug Recommendation

When treating ache, comply with a step-by-step strategy and proceed to the next step if there may be inadequate ache reduction, contraindications, or a particular indication.

Begin with paracetamol. The subsequent step is an NSAID, probably together with paracetamol. The subsequent step is tramadol, ideally together with paracetamol or an NSAID. The subsequent step is a strong-acting opioid, orally or transdermally, ideally together with paracetamol or an NSAID. The final drug step is subcutaneous or intravenous administration of a strong-acting opioid.

  • For pain with an oncological trigger, strong-acting opioids are often begun instantly, ideally together with paracetamol and/or an NSAID.
  • For breakthrough aches, along with efficient upkeep therapy, be sure that fast-acting painkillers can be found as rescue treatment.

Morphine Indications

  • Acute extreme ache, together with post-operative;
  • persistent extreme ache, particularly at the terminal stage of a sickness;
  • In instances of dyspnoea and acute pulmonary oedema attributable to left ventricular decompensation,
  • Premedication earlier than and as an analgesic throughout anaesthesia;
  • sendolor: extreme acute ache, most cancers ache, and breakthrough ache in most cancers;
  • Offlabel:
    • extreme dyspnoea in palliative sufferers with COPD when bronchodilators and corticosteroids are not present;
    • Offlabel: acute coronary syndrome;
    • offlabel: acute coronary heart failure.

What Should You Discuss With Your Doctor Before Using This Medicine?

  • Být těhotná
    • Opioids cross the placenta.
    • Teratogenicity: In people, inadequate knowledge Teratogenicity and reproductive toxicity have been demonstrated in animals.
    • pharmacological impact: attainable hurt. Extended opioid use, as much as partus, might trigger opioid dependence and neonatal abstinence syndrome (NAS).
      • neklid
      • zvracení
      • elevated urge for food.
      • Podrážděnost
      • hyperaktivita
      • chvění
      • ucpaný nos
      • křeče
      • high-pitched crying. When morphine is given to the mom simply earlier than (2–3 hours) or throughout partus, it might probably scale back the variation of the foetal coronary heart price and trigger respiratory melancholy in the new child. The danger of respiratory melancholy is especially great in preterm infants. Diminished uterine mobility might extend parturition opportunities.
    • Návrh
      • use solely on strict indication.
      • If used throughout partus, naloxone needs to be stored and accessible.
      • Don’t administer systemically throughout partus, but solely regionally within the epidural or intrathecal area.
      • Monitor newborns whose moms used morphine throughout pregnancy for indicators of NAS:
        • If necessary, deal with an opioid.
        • In the case of extreme respiratory melancholy, give an opioid antagonist.
    • Watch out for the ethanol within the drink.
    • Plodnost: chromosomal harm in germ cells and decreased plodnost might happen. Fertile women and men ought to use efficient contraception.

  • Laktace
    • Přechod v mateřském mléce: sure, in larger concentrations than in maternal plasma.
    • Farmakologický dopad: respiratory melancholy and antagonistic impact on the central nervous system.
    • Návrh: Don’t use it.

  • Kontraindikace
    • acute respiratory melancholy;
      • bronchial asthma and persistent obstructive pulmonary illness, extreme presence of bronchus secretion or cyanosis;
    • anxiety or agitation throughout the impact of alcohol or hypnotics; coma, therapy-resistant convulsive problems;
    • bile and bile duct surgical procedures, paralytic ileus, bile colic, acute liver illness, extreme stomach aches, peritonitis.

Morphine Drug Interactions

  1. Concomitant use of alcoholic drinks and different centrally depressant substances might potentiate the depressant impact on the central nervous system.
  2. Mixture with sedatives, equivalent to
    • Benzodiazepiny
    • can result in sedation.
    • respirační melancholie
    • coma and died.
  3. Together with -blockers, elevated inhibition of the central nervous system and elevated results of -blockers might happen.
  4. The concomitant use of some morphinomimetics with MAOIs will increase the danger of a serotonergic syndrome.
  5. Together with vitamin Okay antagonists, a rise in INR with bleeding has been reported.
  6. Even in small portions, alcohol can improve the respiratory-depressant impact of morphine.
  7. Cimetidine, nimodipine, methylphenidate, a gabapentin might improve the analgesic impact of morphine.
  8. Tricyclic antidepresiva improve the analgesic impact of morphine.
  9. Mixed opioid agonists and antagonists might scale back the analgesic impact of morphine by aggressive blocking of receptors.
  10. Ritonavir might lower plasma levels of morphine by inducing glucuronidation.
  11. Rifampicin might decrease the plasma concentration of morphine.
  12. The options of morphine sulphate and 5-fluoro-uracil are incompatible.

Morphine Dosage

  1. Acute and persistent extreme aches
    • Dospělí
      • Oral: 10-20 mg every time, every 4 hours if necessary.
    • aged
      • 5-10 mg every time.
    • Děti
      • Oral: à Terme neonate 0.05-0.1 mg/kg every 4 hours; 1 month–18 years 0.1-0.2 mg/kg every 4 hours.
      • Rectal: à terme neonate 0.1-0.2 mg/kg every 4 hours; 1 month–18 years 0.2-0.4 mg/kg every 4 hours.
      • I.v. : untimely (gestational age  37 weeks) or à terme neonate:
        • beginning dose of 0.05-0.1 mg/kg in 60 min.
        • upkeep dose of 0.003-0.02 mg/kg/h as a steady infusion. 
      • With PCA pump: 5-18 years: 1 mg/kg in 50 ml sodium chloride resolution (= 20 microg/kg/ml):
        • bolus of 1 ml (equals 20 microg/kg)
        • lock-out interval of 10 min.
        • A background infusion of 0.25 ml/h throughout the first 24 hours (= 5 microg/kg/h)
      • S.c.: 1 month-18 years:
        • beginning dose of 0.05-0.1 mg/kg as soon as
        • Upkeep dosage of 0.01 mg/kg/h as a steady infusion
        • max. of 0.03 mg/kg/h in non-ventilated sufferers. 
      • i.m.: 3 months–18 years: 0.1 mg/kg as soon as
  2. Renální poškození
    • Severe antagonistic reactions might happen attributable to decreased renal clearance: a lively metabolite is excreted by way of the kidneys. Titrate fastidiously; in the case of reasonable renal insufficiency (creatinine clearance  30 ml/min), maintain 75% of the standard dose; in the case of extreme renal insufficiency ( 30 ml/min), maintain 50% of the standard dose interval.

  3. Porucha funkce jater
    • The elimination half-life will increase. In the case of severely impaired liver function, take into account lowering the frequency of administration by half (doubling the administration interval).
      • aged
        • Begin with a lower dose and titrate individually based on response. The elimination course is slower; discounting of the day-to-day dose could also be obligatory, particularly with steady administration of morphine.

  4. Cardiac bronchial asthma
    • Dospělí
      • Intravenous: 5-10 mg every time. For the aged, take into account beginning with 2.5 mg and repeating this dose if necessary.

  5. Extreme dyspnoea within the palliative section in sufferers with COPD
    • Dospělí
      • Beginning dose: 5 mg orally or 2.5-5 mg s.c., 4-6/day. If the impact is inadequate, improve the dosage by 50%.
      • Give the day by day dose as morphine in retarded form.
      • If obligatory, give a further 15% of the 24-hour dose (in non-retarded kind).

  6. suspected acute coronary syndrome off label.
    • Dospělí (včetně věku)
      • 4-5 mg (0.1 mg/kg physique weight) i.v. in 4-5 min;
      • with an age > 65 years or coronary heart failure: 2.5-5 mg (0.05 mg/kg physique weight).

  7. Offlabel: acute coronary heart failure
    • Dospělí
      • 4-5 mg (0.05 mg/kg) i.v. in 4-5 min: repeat if obligatory after 10 to twenty minutes.

Proper Usage of Morphine

  1. Take the pill completely.
  2. With Oramorph 20 mg/ml, measure out the quantity of liquid with the provided pipette/dropper, drop right into a glass of liquid and drink it instantly. The two mg/ml resolution might be drunk instantly. If a morphine drink is taken undiluted, drink adequate liquid afterwards to stop tooth decay.
  3. The ampoule containing the injection fluid might be diluted with 0.9% physiological saline resolution; that is really useful in youngsters. Morphine salts are incompatible with the sodium salts of barbiturates and fenytoin;
  4. An intravenous administration might improve the frequency of antagonistic reactions. In youngsters, administer very slowly;
  5. In the case of poor circulation, morphine needs to be given slowly i.v. as it’s hardly absorbed s.c.

Příznaky předávkování

  • pin-point pupils
  • probably deadly respiratory melancholy.
  • muscle weakness point
  • bradykardie
  • hypotenze
  • From stupor to coma, central nervous system melancholy
  • aspiration pneumonia
  • shock
  • Circulatory collapse
  • srdeční zástava

The affected person becomes cyanotic and the upper airway becomes obstructed because the laryngeal and tongue muscle groups slacken. The pupils often grow smaller, muscle tone decreases, and the pores and skin feel chilly and clammy.

Morphine Precautions

impaired respiratory function as in emphysema:

  • extreme bronchial asthma, extreme cor pulmonale, extreme mucus formation within the respiratory tract and in extreme weight problems; in elevated intracranial stress;
  • Heart problems, hypotension accompanied by hypovolaemia, shock phenomena;
  • untreated myxaemia or poisonous psychosis;
  • biliary tract illness, pancreatitis, inflammatory bowel illness,
  • delirium tremens, alcohol intoxication;
  • prostatic hyperplasia;
  • convulsive problems;
  • Myasthenia gravis

In extreme hepatic and renal impairment, hypothyroidism, and in young and aged people, the dosage needs to be adjusted. Use excessive warning in patients with impaired renal or hepatic function and suspected gastrointestinal emptying. Severe intra-abdominal issues, equivalent to intestinal perforation, could also be masked by the analgesic impact of morphine.

Use can result in habituation and dependence. The danger of that is elevated with longer use and better doses. Warning needs to be exercised in sufferers susceptible to habit, e.g., with a historical past of alcohol or drug abuse. If therapy is discontinued, do so slowly to keep away from withdrawal symptoms. If the incidence of opioid-induced hyperalgesia doesn’t respond to additional doses, scale back the dose, if necessary, or change to a different opioid.

Morphine Side Effects

  • irregular ideas
  • Reminiscence and focus problems
  • dependence
  • decreased cough reflex.
  • allodynia
  • hyperalgesia
  • Hyperhidrosis
  • Abstinence syndrome
  • motion problems
  • muscle rigidity
  • myoclonus
  • Liver enzyme adjustments
  • biliary spasm
  • třes
  • stressed legs syndrome
  • průjem
  • Stomach colic
  • nevolnost
  • příznaky podobné chřipce
  • tachykardie
  • mydriáza
  • dysphoria
  • úzkost
  • Podrážděnost

Zřeknutí se odpovědnosti

Information concerning psychotic disorders, included within the review of Morphine, is used for the informative features exclusively and should not be thought of as an alternative to licenced healthcare or referral from the well-being treatment distributor.

 

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Často kladené otázky

  • What is Morphine?

    Morphine is an opioid medication. An opioid is sometimes called a narcotic. Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain.

  • Co dělat, když vynecháte dávku?

    If you miss a dose of Morphine, take it as quickly as potential. However, whether it is virtually time to your subsequent dose, skip the missed dose and return to your common dosing schedule. Do not double doses.

  • What if u take too much Morphine?

    Pokud dojde k předávkování, pojmenujte svého lékaře nebo zavolejte do nejbližší nemocnice. Možná máte naléhavou lékařskou péči. Můžete se také obrátit na správu jedů ve vaší místní nemocnici.

  • How to store Morphine?

    Store at room temperature, away from heat, moisture, and light.

  • What Should I Avoid While Taking Morphine?

    Avoid consuming alcohol or utilizing unlawful medicine when you are taking Morphine. They might lower the advantages (e.g. worsen your confusion) and improve hostile results (e.g. sedation) of the remedy.

  • What are the side effects of Morphine?

    Common morphine side effects may include drowsiness, dizziness, tiredness; constipation, stomach pain, nausea, vomiting; sweating; or feelings of extreme happiness or sadness.


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