Therapeutic action
Indications
Forms and
strengths
Dosage
Duration
Contra-indications,
adverse effects,
precautions
Remarks
Storage
MORPHINE immediate-release (MIR) oral
MORPHINE sustained-release (MSR) oral
Centrally acting opioid analgesic
Severe pain
• 15 mg immediate-release tablet
• 10 mg/5 ml oral solution, for pediatric use
Centrally acting opioid analgesic
Severe and persistent pain, especially cancer pain
• 10 mg, 30 mg and 60 mg sustained-release
capsules or tablets
• Usually, the effective daily dose is determined during
the initial treatment with immediate-release morphine
(MIR). When the changing from MIR to MSR, the
daily dose remains the same.
For example, if effective dose of MIR is 20 mg every
4 hours (120 mg daily), the dose of MSR is 60 mg
There is no standard dose. The optimal dose is
every 12 hours (120 mg daily).
that which provides efficient pain relief to the
• If treatment is initiated directly with MSR:
patient. It is adjusted in relation to the regular
o Child over 6 months: initially 0.5 mg/kg every 12
hours
assessment of pain intensity and the incidence of
o Adult: initially 30 mg every 12 hours
adverse effects.
• Patients stabilized on MSR may require rescue
doses of MIR in the event of episodic (breakthrough)
pain. A rescue dose corresponds to 10% of the daily
MSR dose. If a patient regularly requires more than 3
rescue doses per day, increase the daily MSR dose
by the sum of rescue doses.
According to clinical response. Do not stop long-term
Once the pain is controlled, change to sustainedtreatment abruptly. Decrease doses progressively to
release morphine.
avoid withdrawal symptoms.
• Do not administer to patients with severe respiratory impairment or decompensated hepatic impairment.
• Do not initiate treatment with the sustained-release formulation in elderly patients or those with renal or hepatic
impairment. Begin treatment with the immediate release formulation (MIR).
• May cause:
o dose-related sedation and respiratory depression, nausea, vomiting, constipation, urinary retention,
confusion, raised intracranial pressure, pruritus;
o in the event of overdose: excessive sedation, respiratory depression, coma.
• Management of respiratory depression includes assisted ventilation and/or administration of naloxone. Monitor
patient closely for several hours.
• Administer with caution to patients with respiratory impairment, head injury, raised intracranial pressure,
uncontrolled epilepsy or urethroprostatic disorders.
• Do not combine with opioid analgesics with mixed agonist-antagonist activity such as buprenorphine,
nalbuphine, pentazocine (competitive action).
• Increased risk of sedation and respiratory depression, when combined with alcohol and drugs acting on the
central nervous system: benzodiazepines (diazepam, etc.), neuroleptics (chlorpromazine, haloperidol, etc.),
antihistamines (chlorphenamine, promethazine), phenobarbital, etc.
• Pregnancy and breast-feeding: no contra-indication. The child may develop withdrawal symptoms, respiratory
depression and drowsiness when the mother receives morphine at the end of the 3 rd trimester and during
breast-feeding. In these situations, administer with caution, for a short period, at the lowest effective dose, and
monitor the child.
•
Administer an appropriate laxative (e.g., lactulose)
if analgesic treatment continues more than 48
•
Administer an appropriate laxative (e.g. lactulose) if
hours.
analgesic treatment continues more than 48 hours.
•
The morphine dose in tablets is not suitable for
•
Do not crush or chew capsules. They can be
young children. Use oral solution instead. If this is
opened and emptied into food.
not available, use injectable morphine by the oral
•
Morphine is on the list of narcotics: follow national
route: dilute an ampoule of 10 mg/ml (1 ml) with 9
regulations.
ml of water to obtain a solution containing 1 mg/ml.
•
Morphine is on the list of narcotics: follow national
regulations.
Below 25 °C
Below 25 °C