How much morphine sulfate should i take

It also reduces the anxiety and stress caused by pain. When morphine blocks the pain, there are other unwanted effects, for example, slow or shallow breathing. It also slows down digestion, which is why morphine can cause constipation.

Fast-acting morphine taken by mouth works in 30 to 60 minutes but it wears off after 4 to 6 hours. Slow-acting morphine taken by mouth can take a day or 2 to start working but the pain relief will last for longer. It's difficult to say how long morphine suppositories take to work, as it varies from person to person. Yes, morphine is addictive. If you need to take it for a long time your body can become tolerant to it.

That means you need higher doses to control your pain. But in reality, if you're taking morphine to relieve pain rather than using it as a recreational drug it's very unlikely you will get addicted to it because you're not taking it to get a "high". If you're addicted to morphine, you may find it difficult to stop taking it or feel you need to take it more often than necessary.

And if you stop taking morphine suddenly you may suffer from withdrawal symptoms. These include agitation, anxiety, nervousness, panic attacks, difficulty sleeping, shaking, over-activity, pins and needles or ringing in the ears.

Talk to your doctor if you're worried about addiction or if you want to know more about how to prevent withdrawal symptoms. Morphine is a controlled medicine. This means there are strict rules on how it's prescribed and dispensed to make sure it's not given to the wrong person or misused. When you collect morphine your pharmacist will ask for proof of your identity such as your passport or driving licence. You'll also be asked to sign the back of your prescription, to confirm that you've received it.

If you're collecting morphine for someone else, you're legally required to show the pharmacist proof of your identity if asked. Fast-acting morphine tablets are also known as Sevredol. Slow-acting capsules are also known as MXL or Zomorph.

However, it may interfere with your periods menstrual cycle if you're a woman. Speak to a pharmacist or your doctor if you're trying to get pregnant.

They may want to review your treatment. Morphine does not affect any type of contraception including the contraceptive pill or emergency contraception. But if morphine makes you sick vomit , your contraceptive pills may not protect you from pregnancy. If this happens, follow the instructions in the leaflet that comes with your contraceptive pills. Find out what to do if you're on the pill and you're sick. It may be best not to drink alcohol while taking morphine as drinking alcohol while you're on morphine may make you feel more sleepy or increase the risk of serious side effects.

It's best to stop drinking alcohol during the first few days of treatment until you see how the morphine affects you. The type of painkiller that's best depends on what type of pain you have and the cause of your pain.

If morphine does not get rid of your pain or becomes less effective, discuss this with your doctor. When you first take morphine, you'll probably feel sleepy for a few days. But the sleepiness will wear off after a few days as your body gets used to the medicine. You might notice you are less alert. In this case, you might choose to have less than perfect pain relief as a trade-off. Morphine is not only used at the end of a terminal illness. It's the amount of pain you have, not the stage of your illness, that decides whether morphine is prescribed for you.

Morphine can be used safely in babies and children of all ages, although the dose is usually lower than for adults. Do not drive a car or ride a bike if morphine makes you sleepy, gives you blurred vision or makes you feel dizzy, clumsy or unable to concentrate or make decisions.

This may be more likely when you first start taking morphine but could happen at any time, for example, when starting another medicine. It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive. It may be best not to drink alcohol while taking morphine as you're more likely to get side effects like feeling sleepy. Even if your ability to drive is not affected, the police have the right to request a saliva sample to check how much morphine is in your body.

UK has more information on the law on drugs and driving. Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking morphine. If you take recreational drugs, such as cannabis, cocaine and heroin, while you're taking morphine, you're more likely to get the serious side effects of morphine including breathing difficulties, heart problems such as high blood pressure, seizures and even going into a coma.

Some recreational drugs, such as cannabis, will also increase morphine side effects such as sleepiness and dizziness. Taking heroin while you're on prescribed morphine is especially dangerous.

You're more likely to get all the side effects of morphine, including addiction. Page last reviewed: 23 November Next review due: 23 November About morphine Morphine is a strong painkiller. Morphine works by blocking pain signals from travelling along the nerves to the brain. The most common side effects of morphine are constipation, feeling sick and sleepiness. It's possible to become addicted to morphine, but this is rare if you're taking it to relieve pain and your doctor is reviewing your treatment regularly.

Tell your doctor before starting the medicine if you : have ever had an allergic reaction to morphine or any other medicine have breathing difficulties or a lung problem have an addiction to alcohol have a condition that causes fits or seizures have a head injury have low thyroid levels have adrenal gland problems have kidney or liver problems have an enlarged prostate have low blood pressure have myasthenia gravis a rare illness that causes muscle weakness are trying to get pregnant, are already pregnant or if you're breastfeeding — morphine is usually not recommended.

It's important to take morphine as your doctor has asked you to. Different types of morphine Morphine comes as: tablets fast-acting — these contain 10mg, 20mg or 50mg of morphine tablets slow-acting — these contain 5mg, 10mg, 15mg, 30mg, 60mg, mg or mg of morphine capsules slow-acting — these contain 10mg, 30mg, 60mg, 90mg, mg, mg or mg of morphine granules that you mix in water to make a drink — these are in sachets containing 30mg, 60mg, mg or mg of morphine a liquid that you swallow — this contains either 10mg of morphine in a 5ml spoonful or 20mg of morphine in 1ml of liquid suppositories — these contain 10mg of morphine injection usually given in hospital Morphine suppositories are useful if you cannot swallow tablets or liquids.

Dosage Doses vary from person to person. How often will I take it? How often you take it depends on the type of morphine that you've been prescribed. Important Do not break, crush, chew or suck morphine slow-release tablets or capsules. Will my dose go up or down? How long will I take it for? What if I forget to take it? This will vary depending on which type of morphine you're taking. Back Podcasts. Back Quality and Practice Management. Back Research and Publications.

Back Member Center. Back About ASA. Research and Publications Lead the direction of our specialty by engaging in academic, research, and scientific discovery. Demonstrate Your Value Quality reporting offers benefits beyond simply satisfying federal requirements. Your Membership Pays You Back Community, collaboration, and evidence-based information are more valuable than ever. The mg per 5 mL concentration of morphine sulfate may cause fatal respiratory depression when administered to patients not previously exposed to opioids.

Administration of morphine via neuraxial routes requires an experienced clinician familiar with administration techniques, proper dosing, and potential patient management problems that may occur with epidural or intrathecal administration. Since single-dose neuraxial administration may result in serious adverse reactions, including acute or delayed respiratory depression, administration requires a specialized care setting where patients can be observed for up to 24 hours following the initial dose, including the initial test dose of Infumorph.

The facility must be in fully equipped to monitor patients and resuscitate any patient with severe opioid overdosage. Personnel must be familiar with the use of opioid antagonists. Continue to monitor patients receiving Infumorph during the first several days following catheter implantation. Epidural administration has been associated with less potential for immediate or late adverse reactions e. For safety concerns, limit Duramorph administration by the intrathecal or epidural routes to the lumbar area; thoracic administration has been shown to greatly increase the incidence of early and late respiratory depression even at doses of 1 to 2 mg.

Similarly, limit Infumorph administration by the intrathecal route to the lumbar area. Parenteral administration of other opioids in patients receiving epidural or intrathecal morphine may result in overdosage. Use caution when morphine is also given intravenously; because of a delay in maximum CNS effects 30 minutes with intravenous morphine, rapid administration may result in overdose.

Several factors contraindicate the administration of morphine by the epidural or intrathecal routes. These factors include infection at the injection site, concomitant anticoagulant therapy, uncontrolled coagulopathy, or the presence of any other concomitant therapy or medical condition which would render epidural or intrathecal administration of medication especially hazardous.

Although all forms of morphine have potential for overdose or poisoning, certain formulations are associated with specific risks. Knowledge and care in product selection is advised. Excessive doses may be a result of morphine oral solutions prescribed in milligrams and erroneously interchanged for milliliters of the product.

To reduce the risk of life-threatening adverse effects, several formulations of morphine are intended for opioid-tolerant patients only. Only use extended-release morphine e. Morphine should be kept out of the reach of pediatric patients and others for whom it was not prescribed, as accidental exposure may cause a fatal overdose.

Published studies with morphine use during pregnancy have not reported a clear association with morphine and major birth defects. Results for a population-based prospective cohort, including women exposed to morphine at any time during pregnancy and 70 women exposed during the first trimester of pregnancy, indicate no increased risk for congenital malformations; however, risk cannot be excluded due to study methodological limitations. Neural tube defects i. Lower fetal body weight and increased abortion incidence were observed at 0.

Doses of 3 to 4 times the human daily dose given during organogenesis and throughout lactation have produced cyanosis, hypothermia, decreased brain weight or body weight, adverse effects on reproductive tissues, and death in rats.

Some long-term neurochemical changes in the brains of rat offspring which correlate with altered behavioral responses that persist through adulthood have been observed with exposures comparable to and less than the human daily dose. Some experts suggest increased risk if morphine is used for prolonged periods during pregnancy or at high doses near term. While certain formulations of morphine have been used in the obstetric setting, caution is advised under various circumstances during labor and obstetric delivery.

Morphine sulfate extended-release liposome injection DepoDur should not be administered to women for vaginal labor and delivery; this formulation is only for pain associated with Caesarian section after delivery and clamping of the umbilical cord. Morphine sulfate extended-release tablets or capsules are not recommended for use during or immediately prior to labor. Morphine readily crosses the placenta and all other formulations should be used cautiously during pregnancy or obstetric delivery.

An opioid antagonist and resuscitative equipment should be readily available. If used during the second stage of labor, the duration of labor can be prolonged by temporarily reducing the strength, duration, and frequency of uterine contractions. However, this effect is not consistent and may be offset by an increased rate of cervical dilation.

Further, prolonged maternal use of long-acting opioids, such as morphine, during pregnancy may result in neonatal opioid withdrawal syndrome NOWS. Severe symptoms may require pharmacologic therapy managed by clinicians familiar with neonatal opioid withdrawal. Monitor the neonate for withdrawal symptoms including rapid breathing, irritability, hyperactivity, abnormal sleep pattern, high-pitched crying, tremor, vomiting, diarrhea, and failure to gain weight. Onset, duration, and severity of opioid withdrawal may vary based on the specific opioid used, duration of use, timing and amount of last maternal use, and rate of elimination by the newborn.

Opiate agonist; alkaloid obtained from the unripened seed capsules of the opium poppy Used for the relief of moderate to severe acute and chronic pain, preoperative sedation and as a supplement to anesthesia Available in multiple formulations. Do not use Kadian capsules as a first opioid analgesic; initiate with an immediate-release formulation and then convert patients to Kadian. With the exception of Avinza, adjust the dose every 1 to 2 days based upon the total daily morphine requirements extended-release dose plus breakthrough doses.

Adjust the dose of Avinza every 3 to 4 days in increments of 30 mg or less. Monitor patients frequently for respiratory depression, particularly during the first 24 to 72 hours after initiation or dose escalation. Discontinue all other around-the-clock opioids. To convert from other morphine formulations, calculate the morphine hour oral requirement; in general, the hour oral requirement is 3 times the hour parenteral requirement.

When initiating extended-release morphine, anticipate and treat breakthrough pain with adequate doses of immediate-release morphine as needed. When converting from other opioids, established conversion ratios to extended-release formulations have not been defined by clinical trials.

Alternatively, initiate with one-half of the calculated morphine hour oral requirement estimate, anticipating breakthrough pain and providing adequate doses of immediate-release morphine as needed. When converting from methadone, potency ratios to convert to other opioids can vary widely, warranting extreme caution during conversion to extended-release morphine to avoid overdosage.

With the exception of Avinza, adjust dosage every 1 to 2 days based on total daily morphine requirements extended-release dose plus breakthrough doses. Adjust Avinza dose every 3 to 4 days. Monitor frequently for respiratory depression, especially 24 to 72 hours after initiation or dose escalation. Although FDA-approved product labeling provides adult dosing for both opioid-naive and opioid-tolerant patients, it would be prudent to limit pediatric use to opioid-tolerant patients.

Limited data are available, and there is wide variability in dosage needs. Doses of 0. Begin at the lower end of the dosage range, and titrate to pain relief. Do not exceed recommended adult doses; the initial adult dosage recommendation is 15 mg PO every 8 to 12 hours, with the longer interval used in opioid-naive patients. Many experts recommend beginning with an immediate-release product to titrate to an appropriate daily dose and then switch to an extended-release formulation and divide the patient's total daily dose into 2 or 3 equal doses.

Extended-release morphine should not be used for as needed analgesia and is only appropriate for a select group of children; only clinicians highly experienced in pediatric pain management should prescribe extended-release formulations.

Initially, 15 to 30 mg PO every 4 hours as needed. Titrate to pain relief. When converting parenteral to oral morphine, an oral dose that is 3 times the parenteral dose is generally sufficient. When converting from extended-release morphine, give the same hour total as a divided regimen given at appropriate intervals. When converting from other oral or parenteral opioids, calculate the hour total dose of the current opioid and consult published relative potency information for conversion.

Monitor for sedation and respiratory depression, particularly when therapy is initiated or dosage changes occur. To discontinue, gradually taper the dose to prevent signs and symptoms of withdrawal. General weight-based dosing for pediatric patients is 0. Initially, 10 to 20 mg PO every 4 hours as needed. Higher doses 10 mg are recommended for IM or subcutaneous administration; dosage may range from 5 to 20 mg IM or subcutaneously every 4 hours depending on patient requirements and response.

NOTE: Continuous infusions should only be used in acute care settings e. Loading doses of 15 to 20 mg may be required for adequate analgesia; higher doses may be needed in opioid-tolerant patients. Higher infusion rates may be required in opioid-tolerant patients.

Titrate dose to pain relief. A bolus of 0. Initial infusion rates of 0. Alternatively, rates of 0. Higher maintenance infusion rates up to 0. May increase up to 0. An initial infusion rate of 0.

The mean infusion rate was 0. Higher infusion rates, ranging from 0. The starting dose should be based on the patient's recent exposure to opioids. Titrate the regimen to patient response. Larger doses may be needed in opioid-tolerant patients. Various regimens have been reported. The following settings have been used in pediatric patients; titrate regimen to patient response.

Demand dose: 0. Initially, inject 5 mg epidurally in the lumbar region and assess the patient in 1 hour; if pain relief is not adequate at that time, administer incremental doses of 1 to 2 mg, with sufficient time between injections to appropriately assess for efficacy.

The manufacturer recommends a maximum of 10 mg per 24 hours. For continuous epidural infusion, initiate at 2 to 4 mg per 24 hours, with additional doses of 1 to 2 mg given if pain relief is not initially achieved. The incidence of early and late respiratory depression is dramatically increased with thoracic administration. Use preservative-free formulations only.

Various regimens have been reported including single preoperative and postoperative doses of 0. Intrathecal dosage is usually one-tenth the epidural dosage. Single preoperative doses of 0. Use preservative free formulations only.

Use caution in geriatric patients due to the potential for adverse CNS effects; and consider alternative drugs for treatment. Use caution in geriatric patients due to the potential for adverse CNS effects; consider alternative drugs for treatment. Although no published studies exist on the effectiveness of nonspecific antimotility agents in treating AIDS-associated diarrhea, opioid agonists may be effective. Doses are given in addition to other opiate pain medications.

Initially, 2 to 5 mg IV every 5 to 30 minutes as needed for pain; some patients may require maintenance doses of 4 to 8 mg IV every 4 to 6 hours. Premedication with a benzodiazepine may potentiate the response to morphine; a reduced morphine dose may be needed. Use the lower end of the range for opioid-naive neonates. Onset is typically 5 minutes.

Use a preservative-free formulation. Use an initial dosage of 15 mg PO twice daily in those who are not opioid tolerant, and consider this lower dose in geriatric patients or those weighing less than 60 kg. For Kadian, Avinza, and equivalent generic dose forms that may be given once daily, the highest starting dose for patients who are not opioid tolerant is 30 mg PO every 24 hours [Kadian is administered at a frequency of either once daily every 24 hours or twice daily every 12 hours ; Avinza is administered at a frequency of once daily every 24 hours ].

Clinical practice guidelines classify morphine as probably effective for the treatment of painful diabetic neuropathy. Initially, 0. Once the patient is on a stable dose, individualize weaning based on the patient's symptoms. Titrate based on efficacy and adverse effects.

Longer-acting and controlled-release drugs are preferred, especially at night. Camphorated opium tincture 0. Extended-release capsules, extended-release tablets Arymo ER or Morphabond , DepoDur liposome injection: Safety and efficacy have not been established.

Immediate-release formulations, injectable solution NOT DepoDur : With appropriate dosage titration, there is no maximum dose. Extended-release formulations, DepoDur liposome injection: Safety and efficacy have not been established. With the exception of morphine sulfate extended-release liposome injection, which is only used as a single epidural dose, morphine dosage should be modified depending on clinical response and degree of hepatic impairment.

Begin treatment with a lower than usual initial dosage, and titrate slowly while monitoring for sedation, respiratory depression, and hypotension. The 6-glucuronide and 3-glucuronide metabolites are renally eliminated. With the exception of morphine sulfate extended-release liposome injection, which is only used as a single epidural dose, morphine dosage should be modified to prevent accumulation of the metabolite and excessive side effects.

NOTE: If Duramorph or Infumorph gets on the skin, remove any contaminated clothing and rinse the affected area with water. When initiating therapy, begin with an immediate-release preparation and titrate to the appropriate analgesic dose and then convert the patient to an extended-release product if appropriate. Storage: Store morphine securely in a location not accessible by others. Disposal: Flush unused morphine down the toilet when it is no longer needed if a drug take-back option is not readily available.

Immediate-release Tablets Administer without regard to meals; may be given with food or milk to minimize gastrointestinal irritation. Capsule contents may be added to juice and administered immediately or delivered via gastric or nasogastric tube by either adding to or following with liquid.

Extended-release Tablets e. Swallow Arymo tablets 1 at a time immediately after placing in the mouth. Do not pre-soak, lick, or otherwise wet Arymo tablets prior to placing in the mouth; the tablet may become sticky leading to difficulty in swallowing, choking, gagging, or regurgitation. Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of therapy initiation or dose escalation.

MS Contin and mg tablets or Morphabond mg tablets are only for use in patients in whom tolerance to an opioid of comparable potency has been established. Limit use of a single dose of extended-release tablets more than 60 mg or a total daily dose more than mg to opioid-tolerant patients.

Capsules may be opened and the contents sprinkled on applesauce at room temperature or cooler immediately prior to ingestion; no other food has been tested. The applesauce needs to be swallowed without chewing.

Do not separate applesauce into separate doses; the entire portion should be taken. Discard any unused portion of the capsules after the contents have been sprinkled on the applesauce. Kadian capsules may be administered through a 16 French gastrostomy tube.