Morphine Sulfate Tablets CII
Generic Name and Formulations:
Morphine sulfate 15mg, 30mg; scored tabs.
Various generic manufacturers
Indications for Morphine Sulfate Tablets:
Management of acute and chronic pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.
Limitations Of use:
Use only if alternative treatment options (eg, non-opioid analgesics, opioid combination products) are ineffective, not tolerated, or otherwise inadequate to provide sufficient management of pain.
Use lowest effective dose for shortest duration. Individualize. Tabs: opioid-naive or opioid non-tolerant: initially 15–30mg every 4hrs as needed. Soln: initially 10–20mg every 4hrs as needed. 100mg/5mL strength: for use in opioid-tolerant patients only. Conversion to and from other morphine formulations or other opioids: see full labeling. Withdraw gradually by 25–50% every 2–4 days.
<18yrs: not established.
Significant respiratory depression. Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment. During or within 14 days of MAOIs. Known or suspected GI obstruction, including paralytic ileus.
Abuse potential (monitor). Life-threatening respiratory depression; monitor within first 24–72hrs of initiating therapy and following dose increases. Accidental exposure may cause fatal overdose (esp. in children). COPD, cor pulmonale, decreased respiratory reserve, hypoxia, hypercapnia, or pre-existing respiratory depression; monitor and consider non-opioid analgesics. Adrenal insufficiency. Head injury. Increased intracranial pressure, brain tumors; monitor. Seizure disorders. CNS depression. Impaired consciousness, coma, shock; avoid. Biliary tract disease. Acute pancreatitis. Drug abusers. Renal or hepatic impairment; initiate lower doses and titrate slowly. Reevaluate periodically. Avoid abrupt cessation. Elderly. Cachectic. Debilitated. Pregnancy; potential neonatal opioid withdrawal syndrome during prolonged use. Labor & delivery: not recommended. Nursing mothers: monitor infants.
See Contraindications. Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT3 antagonists, mirtazapine, trazodone, tramadol, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and precipitate withdrawal symptoms. May antagonize diuretics; monitor. Paralytic ileus may occur with anticholinergics. May be potentiated by cimetidine, P-gp inhibitors; monitor. May increase serum amylase.
Constipation, nausea, somnolence, lightheadedness, dizziness, sedation, vomiting, sweating; respiratory depression, severe hypotension, syncope.
Clinical Pain Advisor Articles
- History of Migraine May Be Associated With Higher Risk for Cochlear Disorders
- Radiofrequency Denervation Efficacious in Treating Thoracic Zygapophyseal Joint Pain
- Symptom Severity, Sensory Sensitivity May Indicate Pain Centralization in Chronic Overlapping Pain Conditions
- Stat Consult: Chronic Low Back Pain
- Opioid Misuse May Help Predict Alcohol Dependence Treatment Outcomes
- Consensus Guidelines for the Use of Intravenous Ketamine for Chronic Pain
- Pain Societies Issue Guidelines on Use of Ketamine for the Management of Acute Pain
- Labor Epidural Analgesia Linked to Reduced Likelihood of Successful Breastfeeding
- Novel Oral Treatment Safe, Effective for Migraine Headache Relief
- DFN-02 Nasal Spray Safe, Effective for Acute Treatment of Episodic Migraine
- OnabotulinumtoxinA May Be Effective for Chronic Migraine With Medication Overuse
- FDA Outlines Plan for Increasing Nonprescription Drug Availability
- Prescribed Opioids Difficulties Scale Effective for Assessing Concerns of Patients With Chronic Pain
- Hypoesthesia for Touch and Joint Position Linked to Chronic Pain in MS
- New Laws Are Needed to Protect Health Data Shared Online