Morphine hydrochloride indications. What is morphine

Instructions for medical use

drug

MORPHINE HYDROCHLORIDE

Tradename

Morphine hydrochloride

International non-proprietary name

Dosage form

Solution for injection 1% 1 ml

Composition

1 ml of solution contains

active substance - morphine hydrochloride 10 mg,

excipients:0.1 M hydrochloric acid, water for injection.

Description

Transparent, colorless or slightly yellowish-colored liquid.

Pharmacotherapeutic group

Analgesics. Opioids. Opium alkaloids are natural. Morphine.

ATX code N02AA01

Pharmacological properties

Pharmacokinetics

With subcutaneous and intramuscular administration, it is rapidly absorbed into the systemic circulation. After intravenous administration morphine is distributed in organs and tissues. Within 10 minutes, 96-98% of this drug disappears from the blood plasma.

The connection with proteins is low - 30-35%. Penetrates the blood-brain, placental barriers (can cause depression of the respiratory center in the fetus), is determined in breast milk... The volume of distribution of morphine is relatively large and amounts to 4 l / kg, which indicates its intensive absorption by tissues, including skeletal muscles. The analgesic effect develops 5-20 minutes after subcutaneous and intramuscular injection, lasts 4 - 5 hours. In the period from 15 minutes to 3 hours, the concentration of morphine in the blood is maintained for more high level after intramuscular and subcutaneous administrationthan after intravenous infusion. This is apparently due to the creation of a depot of the drug with intramuscular and subcutaneous injection with subsequent entry into the blood.

Most of the dose is metabolized to glucuronides and sulfates. The half-life is 2-3 hours. It is excreted in the form of metabolites mainly by the kidneys - 90%, the rest - with bile. In case of impaired liver and kidney function, as well as in elderly patients, an increase in the half-life is possible.

Pharmacodynamics

Opioid (narcotic) analgesic. It has a pronounced analgesic effect. Agonist of opioid receptors of the central nervous system (delta, mu and kappa). Excitation of the delta receptors causes analgesia; mu receptors - supraspinal analgesia, euphoria, physical dependence, respiratory depression, excitation of centers vagus nerve; kappa receptors - spinal analgesia, sedation, miosis.

It inhibits the interneuronal transmission of pain impulses in the central part of the afferent pathway, reduces the emotional assessment of pain, causes euphoria, which contributes to the formation of addiction (physical and mental). By reducing the excitability of pain centers, it has an anti-shock effect. In high doses, it shows sedative activity, causes a hypnotic effect. It inhibits conditioned reflexes, lowers the summation capacity of the central nervous system, and potentiates the effect of deprimating agents. Reduces the excitability of the thermoregulatory center, stimulates the release of vasopressin. It practically does not affect vascular tone. Inhibits the respiratory center, lowers the excitability of the cough center, excites the centers of the vagus nerve, causing bradycardia, stimulates the neurons of the oculomotor nerves, constricts the pupil (miosis). May stimulate chemoreceptors in the trigger zones of the medulla oblongata and induce nausea and vomiting. Inhibits the vomiting center, because the use of morphine in repeated doses and emetics, administered after morphine, do not cause vomiting. Increases the tone of smooth muscles internal organs: sphincters of Oddi, bladder, antrum of the stomach, intestines, biliary tract, bronchi. Weakens peristalsis, slows down the movement of food masses, promotes the development of constipation.

It causes addiction and drug (opioid) dependence (morphinism).

Indications for use

• severe pain syndrome (with severe injuries, myocardial infarction, malignant neoplasms, in the postoperative period)
• preoperative premedication

Method of administration and dosage

The dosage regimen is individual.

Adults and adolescents 15 years and older are injected subcutaneously and intramuscularly in 1 ml (10 mg of morphine), intravenously slowly - in 0.5-1 ml (5-10 mg of morphine).

The maximum doses for adults with subcutaneous administration: single - 2 ml (20 mg morphine), daily - 5 ml (50 mg morphine).

Children over 2 years of age subcutaneously, depending on age:

in children from 2 to 3 years old, a single dose is 0.1 ml (1 mg morphine), the daily dose is 0.2 ml (2 mg morphine);

3-4 years: single dose - 0.15 ml (1.5 mg), daily dose - 0.3 ml (3 mg);

5-6 years: single dose - 0.25 ml (2.5 mg), daily dose - 0.75 ml (7.5 mg);

7-9 years: single dose - 0.3 ml (3 mg), daily dose - 1 ml (10 mg);

10-14 years: single dose 0.3-0.5 ml (3-5 mg), daily dose - 1-1.5 ml (10-15 mg).

Side effects

• respiratory depression
• bradycardia
• sedative or stimulating effect, especially in elderly patients
• decreased concentration, confusion, delirium, hallucinations, mood changes
• dizziness, headache, drowsiness, general weakness, discoordination of muscle movements, tremor, increased intracranial pressure with the likelihood of subsequent disturbance of cerebral circulation
• nausea, vomiting, dry mouth, stomach cramps, constipation
• biliary tract spasm, cholestasis
• impaired outflow of urine or aggravation of this condition with prostate adenoma and stenosis of the urethra
• facial hyperemia, skin rash, urticaria, itching, rhinitis, facial edema, laryngospasm (in severe cases - up to Quincke's edema and anaphylactic shock)
• violation of the clarity of visual perception, incl. diplopia, miosis, nystagmus

Contraindications

• individual hypersensitivity to opiates, incl. morphine
• traumatic brain injury
• intracranial hypertension

Stroke

• breathing disorder due to depression of the respiratory center
• tendency to bronchospasm, bronchial asthma
• heart rhythm disturbances
• severe hepatic or renal impairment
• cachexia
• seizures, status epilepticus
• abdominal pain of unknown etiology
• surgical interventions on the biliary tract
• acute alcohol intoxication
• delirium
• simultaneous treatment with monoamine oxidase inhibitors
• febrile syndrome
• pregnancy, period breastfeeding
• childhood up to 2 years

Medicinalth interactionsi am

With the simultaneous use of morphine with beta-blockers and with drugs that have a depressing effect on the central nervous system, it is possible to enhance this action. The simultaneous administration of morphine with butadione leads to the accumulation of morphine. The use with other opioid analgesics causes depression of the central nervous system, respiration, blood pressure... Dopamine reduces the analgesic effect of morphine; cimetidine enhances respiratory depression with morphine. Phenothiazine derivatives and barbiturates enhance the hypotensive effect and respiratory depression with morphine. Long-term use of barbiturates (especially phenobarbital) or narcotic analgesics causes the development of cross-tolerance. Chlorpromazine enhances the analgesic, as well as the miotic and sedative effects of morphine.

When used simultaneously with antidiarrheal drugs, the risk of constipation increases up to intestinal obstruction, urinary retention and respiratory depression. Competitively inhibits the hepatic metabolism of zidovudine and reduces its clearance (the risk of mutual intoxication increases).

special instructions

Before using the drug Morphine hydrochloride, a doctor's consultation is required.

They are not used for pain relief during labor. morphine crosses the placental barrier and can cause respiratory depression in the newborn.

Use with caution in case of impaired liver and kidney function, hypothyroidism, adrenal cortex insufficiency, prostatic hypertrophy, shock, myasthenia gravis, inflammatory diseases gastrointestinal tract, as well as in patients over 60 years of age.

Morphine is highly euphoric. With repeated use of morphine, mental and physical dependence quickly develops (after 2-14 days from the start of treatment). Withdrawal syndrome can occur several hours after the end of a long course of treatment and reach a maximum after 36 to 72 hours.

During the period of treatment, avoid alcohol intake.

Respiratory failure that develops in case of an overdose requires respiratory support and the introduction of an opioid antagonist - naloxone, but its use in drug addicts can lead to the development of a withdrawal syndrome. Supportive therapy is also aimed at removing the patient from shock by administering naloxone. The amount of injected drug depends on the degree of respiratory failure and the degree of coma.

The use of high doses of the drug, especially in elderly patients, can lead to the development of respiratory depression and hypotension with the development of circulatory failure and coma. Development adverse reactions depends on individual sensitivity to opioid receptors. Children over 2 years of age may have convulsions; when used in high doses, progress is possible renal failure... Convulsions are more common in children. The toxicity of morphine hydrochloride depends on the individual sensitivity to morphine and the amount of the drug administered.

Respiratory depression may occur more frequently with intraspinal drug administration.

Features of the influence of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

During the period of treatment with Morphine, you should not drive vehicles and do other potentially dangerous species activities requiring the speed of psychomotor reactions.

Overdose

Symptoms:the earliest and most dangerous manifestation is depression of the respiratory center; cold clammy sweat, confusion, dizziness, drowsiness, decreased blood pressure, miosis, bradycardia, severe weakness, slow breathing difficulties, hypothermia, delirious psychosis, intracranial hypertension (up to cerebrovascular accident), hallucinations, muscle rigidity, seizures, in severe - loss of consciousness, respiratory arrest, coma. Coma manifested by constricted pupils, respiratory depression, which may indicate an overdose. Pupil dilation indicates the development of hypoxia. Pulmonary edema after overdose is common cause lethal outcome.

Treatment:general resuscitation measures, the appointment of antagonists of opioid analgesics (naloxone, nalorphine). A specific antidote for morphine poisoning is naloxone (0.01 mg / kg intravenously, if necessary - every 20-30 minutes, then with a break of 2 hours intramuscularly until breathing is restored). Transfusion therapy, oxygen therapy, peritoneal dialysis are performed. Analeptics are contraindicated.

Release form and packaging

1 ml is poured into syringe-filled ampoules of neutral glass with a dot or a break ring and with two red stripes on the capillary.

A label made of label paper or writing paper is attached to each ampoule.

5 ampoules are packed in a blister strip made of polyvinyl chloride film and aluminum foil.

Contoured cell packages, together with approved instructions for medical use in the state and Russian languages, are placed in cardboard boxes for consumer packaging or corrugated.

Storage conditions

Store in a dark place, at a temperature not exceeding 30 ° C and in accordance with the Decree of the Government of the Republic of Kazakhstan No. 1693 dated November 10, 2000 "On approval of the Rules for exercising state control over the circulation of narcotic drugs, psychotropic substances and precursors in the Republic of Kazakhstan" (with changes and additions as of 26.08.2013)

Keep out of the reach of children!

Storage period

Do not use after the expiration date.

Conditions of dispensing from pharmacies

On prescription

Manufacturer

shymkent, st. Rashidova 81

Marketing Authorization Holder

JSC "Khimfarm", Republic of Kazakhstan

Address of the organization that accepts claims from consumers on the quality of products (goods) in the Republic of Kazakhstan

JSC "Khimfarm", Republic of Kazakhstan,

shymkent, st. Rashidova 81

Phone number 7252 (561342)

Fax number 7252 (561342)

Instructions for the medical use of the drug

Description of the pharmacological action

Stimulates opiate receptors.

Indications for use

Severe pain syndrome (trauma, malignant neoplasms, myocardial infarction, in the postoperative period, etc.), preparation for surgery, insomnia associated with severe pain, cough, severe shortness of breath in acute cardiovascular failure.

Release form

1 ampoule with 1 ml of solution for injection contains morphine hydrochloride 0.01 g; in the package 5 pcs.
solution for subcutaneous administration 10 mg / ml; syringe tube 1 ml, box (box) 100;

Pharmacodynamics

Stimulates mu-, delta- and kappa-subspecies of opioid receptors. It inhibits the interneuronal transmission of pain impulses in the central part of the afferent pathway, reduces the emotional assessment of pain, the reaction to it, causes euphoria (the mood rises, there is a feeling of mental comfort, complacency and bright prospects, regardless of the real state of affairs), which contributes to the formation of dependence (mental and physical). Reduces the excitability of the heat regulation center, stimulates the release of vasopressin. It practically does not affect vascular tone. In high doses, it exhibits sedative activity, inhibits the respiratory, cough, and, as a rule, the vomiting centers, excites the centers of the oculomotor (miosis) and vagus (bradycardia) nerves. Increases the tone of the smooth muscles of the sphincters of the gastrointestinal tract with a simultaneous decrease in peristalsis (locking effect). May stimulate the chemoreceptors of the vomiting center trigger zone and cause nausea and vomiting.

Supraspinal analgesia, euphoria, physical dependence, respiratory depression, and excitation of the vagus nerve centers are associated with the effect on mu receptors. Stimulation of the kappa receptors causes spinal analgesia, sedation, miosis. Delta receptor excitation produces analgesia.

Pharmacokinetics

It is rapidly absorbed into the blood by any route of administration (inside, s / c and i / m). Easily passes barriers, incl. BBB, placental (can cause depression of the respiratory center in the fetus and therefore is not used for pain relief during labor). It is metabolized, forming mainly glucuronides and sulfates. It is excreted by the kidneys. Small amounts are excreted by all exocrine glands. The analgesic effect develops within 5-15 minutes after s / c and i / m administration, after oral administration - after 20-30 minutes and usually lasts 4-5 hours.

Use during pregnancy

During pregnancy and during breastfeeding, the use is permissible only for health reasons (respiratory depression and the development of drug dependence in the fetus and newborn are possible).

Contraindications for use

General pronounced exhaustion, respiratory failure, childhood (up to 2 years).

Side effects

Nausea, vomiting, respiratory depression; severe euphoria, drug dependence.

Method of administration and dosage

S / c, i / m or i / v. The dosage regimen is individual, the doses depend on the indications, the route of administration, the patient's condition. The highest daily dose for adults is 50 mg (except for incurable cancer patients, in whom it can reach 1 g / day). The frequency of admission is after 12 hours.

Overdose

Symptoms of acute and chronic overdose: cold clammy sweat, confusion, dizziness, drowsiness, decreased blood pressure, nervousness, fatigue, miosis, bradycardia, severe weakness, slow breathing difficulties, hypothermia, anxiety, dryness of the oral mucosa, delirious psychosis, intracranial hypertension (up to a violation of cerebral circulation), hallucinations, muscle rigidity, convulsions, in severe cases - loss of consciousness, respiratory arrest, coma.

Treatment: resuscitation measures, intravenous administration of a specific antagonist of opioid analgesics - naloxone.

Interaction with other drugs

It lengthens and enhances the effect of drugs that inhibit the activity of the central nervous system, incl. hypnotics, sedatives, drugs for general anesthesia, anxiolytics, antipsychotics and local anesthetic drugs. Drugs that depress the central nervous system, incl. ethanol, enhance the deprimating effect and respiratory depression (muscle relaxants also act). With the systematic intake of barbiturates, especially phenobarbital, there is a possibility of a decrease in the severity of the analgesic effect. Caution should be used concurrently with MAO inhibitors because of possible overexcitation or inhibition with the occurrence of hyper- or hypotensive crises (first, to assess the effect of interaction, the dose should be reduced to 1/4 of the recommended). When taken simultaneously with beta-blockers, an increase in the inhibitory effect on the central nervous system is possible, with dopamine - a decrease in the analgesic effect of morphine, with cimetidine - an increase in respiratory depression, with other opioid analgesics - an increase in central nervous system depression, respiration, hypotension. Chlorpromazine enhances the sedative and analgesic effects of morphine. Derivatives of phenothiazine and barbiturates enhance the hypotensive effect and increase the risk of respiratory depression. Naloxone reduces the effect of opioid analgesics, as well as respiratory and central nervous system depression caused by them. Nalorphine eliminates respiratory depression caused by morphine. Enhances the hypotensive effect of drugs that lower blood pressure (including ganglion blockers, diuretics). Competitively inhibits the hepatic metabolism of zidovudine and reduces its clearance (the risk of their mutual intoxication increases). Drugs with anticholinergic activity, antidiarrheal drugs (including loperamide) increase the risk of constipation up to intestinal obstruction, urinary retention and CNS depression. Reduces the effect of metoclopramide.

Morphine can increase the anticoagulant activity of coumarin and other anticoagulants.

Precautions for taking

Morphine should not be used in situations where paralytic ileus may occur. If paralytic ileus is threatened, the use of morphine should be discontinued immediately. In patients with suspected cardiac surgery or other surgery with intense pain, the use of morphine should be discontinued 24 hours before surgery. If therapy is subsequently shown, then the dosage regimen is selected taking into account the severity of the operation.

If nausea and vomiting occur, a combination with phenothiazine can be used.

During the treatment period, care must be taken when managing vehicles and engaging in other potentially hazardous activities that require an increased concentration of attention and speed of psychomotor reactions, do not allow the use of ethanol. The simultaneous use of other drugs acting on the central nervous system (antihistamines, hypnotics, psychotropic drugs, other pain relievers) is allowed only with the permission and under the supervision of a doctor.

It should be borne in mind that children under 2 years of age are more sensitive to the effects of opioid analgesics and may experience paradoxical reactions.

Storage conditions

List A .: In a dark place, at a temperature not exceeding 20 ° C.

Shelf life

Belonging to ATX classification:

** The Drug Guide is intended solely for informational purposes. For more information, please refer to the manufacturer's annotation. Do not self-medicate; you should consult your doctor before using Morphine. EUROLAB is not responsible for the consequences caused by the use of the information posted on the portal. Any information on the site does not replace a doctor's advice and cannot guarantee the positive effect of the drug.

Are you interested in the drug Morphine? Do you want to know more detailed information or do you need a doctor's examination? Or do you need an inspection? You can make an appointment with the doctor - clinic Eurolab always at your service! Top Doctors will examine you, advise, provide help needed and diagnose. you also can call a doctor at home... Clinic Eurolab open for you around the clock.

** Attention! The information provided in this medication guide is intended for healthcare professionals and should not constitute a basis for self-medication. Description of the drug Morphine is given for information purposes only and is not intended to prescribe treatment without the participation of a doctor. Patients need a specialist consultation!

If you are interested in any more medicines and medicines, their descriptions and instructions for use, information on the composition and form of release, indications for use and side effects, methods of application, prices and reviews of medicines, or if you have any other questions and suggestions - write to us, we will definitely try to help you.

Narcotic analgesic. Opioid receptor agonist (mu, kappa, delta). It inhibits the transmission of pain impulses to the central nervous system, reduces the emotional assessment of pain, causes euphoria (improves mood, causes a feeling of spiritual comfort, complacency and bright prospects, regardless of the real state of affairs), which contributes to the formation of drug addiction (mental and physical).

In high doses, it has a hypnotic effect. Inhibits conditioned reflexes, lowers the excitability of the cough center, causes excitation of the center oculomotor nerve (miosis) and n.vagus (bradycardia). Increases the tone of the smooth muscles of internal organs (including the bronchi, causing bronchospasm), causes spasm of the sphincters of the biliary tract and the sphincter of Oddi, increases the tone of the sphincters of the bladder, weakens intestinal motility (which leads to the development of constipation), increases gastric motility, accelerates it emptying (promotes better detection of stomach and duodenal ulcers, spasm of the sphincter of Oddi creates favorable conditions for x-ray examination gallbladder).

May stimulate the chemoreceptors of the vomiting center trigger zone and cause nausea and vomiting. Reduces the secretory activity of the gastrointestinal tract, basal metabolism and body temperature. Depressing the respiratory and vomiting centers (therefore, repeated administration of morphine or the use of drugs that induce vomiting do not cause vomiting).

Supraspinal analgesia, euphoria, physical dependence, respiratory depression, excitation of n.vagus centers are associated with the effect on mu receptors. Stimulation of the kappa receptors causes spinal analgesia, as well as sedation, miosis. Delta receptor excitation produces analgesia.

The action develops 10-30 minutes after SC, 15-60 minutes after epidural or intrathecal administration, 20-60 minutes after rectal administration; after 20-30 minutes - after ingestion. When oral administration simple form, the effect of a single dose taken lasts 4-5 hours, prolonged form - 8-12 hours, with epidural or intrathecal administration - up to 24 hours.

With the i / m administration of 10 mg, the effect develops after 10-30 minutes, reaches a maximum after 30-60 minutes and lasts 4-5 hours.After oral administration of prolonged forms, the onset of the effect is greater than with i / m administration, the maximum effect is after 60 -120 minutes, duration of analgesia - 4-5 hours.

The prolonged form of morphine in an injectable solution is injected only intramuscularly and provides a quick and long-term drug intake into the blood from the injection site. It has no local irritating effect. The duration of action is 22-24 hours. In comparison with the usual solution of morphine, the analgesic effect of prolonged forms develops somewhat later, but lasts longer and, to a lesser extent, causes euphoria, respiratory depression and gastrointestinal motility.

With intravenous administration, the maximum effect develops after 20 minutes and lasts 4-5 hours

With repeated s / c use, drug dependence (morphinism) rapidly develops; with regular ingestion therapeutic dose dependence is formed somewhat more slowly (after 2-14 days from the start of treatment). Withdrawal syndrome may occur several hours after the end of a long course of treatment and reach a maximum in 36-72 hours.

Morphine hydrochloride

pharmachologic effect

Active analgesic (pain reliever) suppressing all types pain sensitivity without turning off consciousness and changing other types of sensitivity.

Indications for use

Pain of various etiologies (traumatic, with malignant neoplasms, ischemic disease hearts, etc.).

Mode of application

Inside, 0.01-0.02 g, subcutaneously 1 ml of a 1% solution; for children (over 2 years old), doses are set according to age. The highest single dose for adults is 0.02 g, the daily dose is 0.05 g.

Side effects

Nausea, vomiting, constipation, respiratory depression. To reduce side effects, anticholinergic agents (atropine, etc.) are simultaneously prescribed.

Contraindications

Respiratory failure old age, general exhaustion; with prolonged use, drug addiction may develop.

Release form

Tablets, 0.01 g; ampoules of 1 ml of 1% solution in a package of 10 pieces.

Storage conditions

List A. In a dark place (according to the rules established for morphine and other drugs).

Synonyms

Morphine, Morphine hydrochloride, Morphine hydrochloride.

Authors

Links

• Official instruction for the drug Morphine hydrochloride.
• Modern medications: complete practical guide... Moscow, 2000.S. A. Kryzhanovsky, M. B. Vititnova.

Attention!
Description of the drug " Morphine hydrochloride"on this page is a simplified and expanded version of official instructions by application. Before purchasing or using the drug, you should consult your doctor and familiarize yourself with the annotation approved by the manufacturer.
The information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide on the appointment of the drug, as well as determine the doses and methods of its use.

Analogs

These are medicines belonging to the same pharmaceutical group that contain different active substances (INN), differ from each other by name, but are used to treat the same diseases.

• - Tablets 200 mg
• - Tablets 200 mg

Indications for use of the drug Morphine

Severe pain syndrome (trauma, malignant neoplasms, myocardial infarction, in the postoperative period, etc.), preparation for surgery, insomnia associated with severe pain, cough, severe shortness of breath in acute cardiovascular failure.

Release form of the drug Morphine

1 ampoule with 1 ml of solution for injection contains morphine hydrochloride 0.01 g; in the package 5 pcs.
solution for subcutaneous administration 10 mg / ml; syringe tube 1 ml, box (box) 100;

Pharmacodynamics of the drug Morphine

Stimulates mu-, delta- and kappa-subspecies of opioid receptors. It inhibits the interneuronal transmission of pain impulses in the central part of the afferent pathway, reduces the emotional assessment of pain, the reaction to it, causes euphoria (the mood rises, there is a feeling of mental comfort, complacency and bright prospects, regardless of the real state of affairs), which contributes to the formation of dependence (mental and physical). Reduces the excitability of the heat regulation center, stimulates the release of vasopressin. It practically does not affect vascular tone. In high doses, it exhibits sedative activity, inhibits the respiratory, cough, and, as a rule, the vomiting centers, excites the centers of the oculomotor (miosis) and vagus (bradycardia) nerves. Increases the tone of the smooth muscles of the sphincters of the gastrointestinal tract with a simultaneous decrease in peristalsis (locking effect). May stimulate the chemoreceptors of the vomiting center trigger zone and cause nausea and vomiting.

Supraspinal analgesia, euphoria, physical dependence, respiratory depression, and excitation of the vagus nerve centers are associated with the effect on mu receptors. Stimulation of the kappa receptors causes spinal analgesia, sedation, miosis. Delta receptor excitation produces analgesia.

Pharmacokinetics of the drug Morphine

It is rapidly absorbed into the blood by any route of administration (inside, s / c and i / m). Easily passes barriers, incl. BBB, placental (can cause depression of the respiratory center in the fetus and therefore is not used for pain relief during labor). It is metabolized, forming mainly glucuronides and sulfates. It is excreted by the kidneys. Small amounts are excreted by all exocrine glands. The analgesic effect develops within 5-15 minutes after s / c and i / m administration, after oral administration - after 20-30 minutes and usually lasts 4-5 hours.

Use of the drug Morphine during pregnancy

During pregnancy and during breastfeeding, the use is permissible only for health reasons (respiratory depression and the development of drug dependence in the fetus and newborn are possible).

Contraindications to the use of the drug Morphine

General pronounced exhaustion, respiratory failure, childhood (up to 2 years).

Side effects of the drug Morphine

Nausea, vomiting, respiratory depression; severe euphoria, drug dependence.

Dosage and administration of the drug Morphine

S / c, i / m or i / v. The dosage regimen is individual, the doses depend on the indications, the route of administration, the patient's condition. The highest daily dose for adults is 50 mg (except for incurable cancer patients, in whom it can reach 1 g / day). The frequency of admission is after 12 hours.

Morphine overdose

Symptoms of acute and chronic overdose: cold clammy sweat, confusion, dizziness, drowsiness, decreased blood pressure, nervousness, fatigue, miosis, bradycardia, severe weakness, slow breathing difficulties, hypothermia, anxiety, dryness of the oral mucosa, delirious psychosis, intracranial hypertension (up to a violation of cerebral circulation), hallucinations, muscle rigidity, convulsions, in severe cases - loss of consciousness, respiratory arrest, coma.

Treatment: resuscitation measures, intravenous administration of a specific antagonist of opioid analgesics - naloxone.

Drug interactions Morphine with other drugs

It lengthens and enhances the effect of drugs that inhibit the activity of the central nervous system, incl. hypnotics, sedatives, drugs for general anesthesia, anxiolytics, antipsychotics and local anesthetic drugs. Drugs that depress the central nervous system, incl. ethanol, enhance the deprimating effect and respiratory depression (muscle relaxants also act). With the systematic intake of barbiturates, especially phenobarbital, there is a possibility of a decrease in the severity of the analgesic effect. Caution should be used concurrently with MAO inhibitors because of possible overexcitation or inhibition with the occurrence of hyper- or hypotensive crises (first, to assess the effect of interaction, the dose should be reduced to 1/4 of the recommended). When taken simultaneously with beta-blockers, an increase in the inhibitory effect on the central nervous system is possible, with dopamine - a decrease in the analgesic effect of morphine, with cimetidine - an increase in respiratory depression, with other opioid analgesics - an increase in central nervous system depression, respiration, hypotension. Chlorpromazine enhances the sedative and analgesic effects of morphine. Derivatives of phenothiazine and barbiturates enhance the hypotensive effect and increase the risk of respiratory depression. Naloxone reduces the effect of opioid analgesics, as well as respiratory and central nervous system depression caused by them. Nalorphine eliminates respiratory depression caused by morphine. Enhances the hypotensive effect of drugs that lower blood pressure (including ganglion blockers, diuretics). Competitively inhibits the hepatic metabolism of zidovudine and reduces its clearance (the risk of their mutual intoxication increases). Drugs with anticholinergic activity, antidiarrheal drugs (including loperamide) increase the risk of constipation up to intestinal obstruction, urinary retention and CNS depression. Reduces the effect of metoclopramide.

Morphine can increase the anticoagulant activity of coumarin and other anticoagulants.

Precautions for taking morphine

Morphine should not be used in situations where paralytic ileus may occur. If paralytic ileus is threatened, the use of morphine should be discontinued immediately. In patients with suspected cardiac surgery or other surgery with intense pain, the use of morphine should be discontinued 24 hours before surgery. If therapy is subsequently shown, then the dosage regimen is selected taking into account the severity of the operation.

If nausea and vomiting occur, a combination with phenothiazine can be used.

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions, and avoid the use of ethanol. The simultaneous use of other drugs acting on the central nervous system (antihistamines, hypnotics, psychotropic drugs, other pain relievers) is allowed only with the permission and under the supervision of a doctor.

It should be borne in mind that children under 2 years of age are more sensitive to the effects of opioid analgesics and may experience paradoxical reactions.

Storage conditions of the drug Morphine

List A .: In a dark place, at a temperature not exceeding 20 ° C.

Shelf life of the drug Morphine

Affiliation of the drug Morphine to the ATX classification:

N Nervous system

N02 Analgesics

N02A Opioids

N02AA Natural opium alkaloids