Morphine

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Morphine is an opioid used for background and breakthrough pain relief.

Indications

  • Pain
  • Dyspnoea

Pharmacokinetics

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Pharmacodynamics

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Dosing and Routes of Administration

Morphine can be given orally and subcutaneously. Given its oral bioavailability, a subcutaneous dose of morphine should be around one-third to one-half of the oral dose.

Doses is an opioid naive patient are age related and typical starting doses may be:

Age Type Starting dose
Young and middle-aged adult Oral immediate release 10-15mg for breakthrough pain
Oral modified release Typically 10mg twice daily
SC stat 5-7.5mg for breakthrough pain
CSCI 15mg over 24 hours
Elderly adult Oral immediate release 5mg for brekathrough pain
Oral modified release Typically 5mg twice daily
SC stat 2.5 for breakthrough pain
CSCI 10mg over 24 hours

Equianalgesic Doses

1mg of SC morphine 
= 3mg of oral morphine
= 1mg of SC oxycodone
= 2mg of oral oxycodone
= 15microgs of SC fentanyl

The table below can be used as a quick reference in converting morphine doses to other opioids and vice versa. These are approximate doses and it is always wise to use caution and be conservative in dosing when undertaking a conversion. The table can be used for background pain control and breakthrough doses.

Morphine Oxycodone Fentanyl Buprenorphine
(milligrams) (milligrams) (milligrams) (milligrams) (micrograms)
Oral SC Oral SC Patch SC Patch
5mg 2.5mg 5mg 2.5mg * 25mcg #
10mg 2.5-5mg 10mg 2.5-5mg * 50mcg #
15mg 5mg 10mg 5mg * 75mcg #
20mg 5-7.5mg 15mg 5-7.5mg * 100mcg #
30mg 10mg 20mg 10mg * 150mcg #
45mg 15mg 30mg 15mg * 225mcg #
60mg 20mg 40mg 20mg * 300mcg #
90mg 30mg 60mg 30mg * 450mcg #
120mg 40mg 80mg 40mg * 600mcg #
180mg 60mg 120mg 60mg * 900mcg #
240mg 80mg 160mg 80mg * 1200mcg #
300mg 100mg 200mg 100mg * 1500mcg #
* a 25 microgram/hour patch of fentanyl = a daily dose of 24×25 = 600 micrograms of fentanyl
# a 20mg buprenorphine patch approximately equals a 12microgram/hour fental patch
Table - Opioid Equivalence


Compatibilities in a CSCI

The following combinations have been described as safe in a continuous subcutaneous infusion:

2 Drug Morphine Compatibilities
Diluent
Morphine + Cyclizine Water
Haloperidol Water or Saline
Hyoscine butylbromide Water
Ketamine Saline
Levomepromazine Water or Saline
Metoclopramide Water or Saline
Midazolam Water or Saline
Octreotide Saline
Ondansetron Water or Saline
Ranitidine Water
Table: Morphine compatibilities
3 Drug Morphine Compatibilities
Diluent
Morphine + Cyclizine + Midazolam Water
Haloperidol + Cyclizine Water
Hyoscine butylbromide Water or Saline
Ketamine Saline
Midazolam Water or Saline
Octreotide Water or Saline
Ranitidine Water
Hyoscine butylbromide + Octreotide Saline
Ondansetron Saline
Ranitidine Water
Levomepromazine + Hyoscine butylbromide Water or Saline
Metoclopramide Water or Saline
Midazolam Water or Saline
Octreotide Water or Saline
Ranitidine # & Water
Metoclopramide + Ondansetron Saline
Ranitidine Saline
Midazolam + Cyclizine Water
Hyoscine butylbromide Water or Saline
Ketamine Water or Saline
Octreotide Water or Saline
Ondansetron Saline
# Add ranitidine last once all other drugs and diluent have been combined

& Precipitation reported with high doses of levomepromazine > 75mg

Table: Morphine compatibilities
4 Drug Morphine Comptabilities
Diluent
Morphine + Cyclizine + Midazolam + Ondansetron Water
Haloperidol + Cyclizine + Octreotide Water
Ranitidine Water
Hyoscine butylbromide + Ranitidine Water
Midazolam + Cyclizine Water
Hyoscine butylbromide Water
Levomepromazine + Hyoscine butylbromide + Octreotide Saline
Ranitidine # & Water
Midazolam + Hyoscine butylbromide Water
Ketamine Saline
Metoclopramide Water or Saline
Ondansetron Water
Metoclopramide + Midazolam + Ketamine Saline
Midazolam + Hyoscine butylbromide + Octreotide Saline
Metoclopramide + Octreotide Water or Saline
Ondansetron + Metoclopramide + Octreotide Saline
# Add ranitidine last once all other drugs and diluent have been combined

& Precipitation reported with high doses of levomepromazine > 75mg

Table: Morphine compatibilties