Jump to content

Morphine: Difference between revisions

From Pharmacopedia
[unchecked revision][checked revision]
← Older edit

MDElliottMD (talk | contribs)

3 user groups
5,186 edits
VisualWikitext
Add Pendell's corner (Poeia)
parser-claude: Morphine MedTemplate refill, Top 300 stub upgrade
 
(One intermediate revision by one other user not shown)
Line 1: Line 1:
{{MedTemplate
{{MedTemplate
| generic           = Morphine
| generic           = Morphine (sulfate)
| brand             =  
| brand             = MS Contin (ER), Kadian (ER), Avinza (ER), Roxanol (IR oral solution), Duramorph (epidural / IT), Astramorph (IV), Infumorph (intrathecal pump), MorphaBond (IR abuse-deterrent)
| structure         =  
| structure         =
| classes           = Opioid, Analgesic
| classes           = [[:Category:Opioid analgesics|Opioid analgesic (natural phenanthrene from opium poppy)]], [[:Category:Schedule II controlled substances|Schedule II controlled substance]], [[:Category:Analgesics|Analgesic]]
| mechanism          = Mu-opioid receptor agonist
| uses              = <vote slug="moderate-severe-acute-pain-use">Moderate to severe acute pain (FDA)</vote>, <vote slug="severe-chronic-pain-use">Severe chronic pain unresponsive to non-opioid alternatives (FDA, with CDC opioid prescribing guidance constraints)</vote>, <vote slug="cancer-pain-use">Cancer pain (FDA; the global gold standard, WHO essential medicine)</vote>, <vote slug="preoperative-analgesia-use">Preoperative analgesia (FDA)</vote>, <vote slug="epidural-intrathecal-pain-use">Epidural and intrathecal pain management (FDA)</vote>
| uses              =  
| starting_dose    = IR oral: 15-30 mg every 4 hours as needed. ER opioid-naive: 15-30 mg every 12 hours. IV/IM/SC: 2-10 mg every 3-4 hours. Epidural / intrathecal: see surgical or palliative-care protocols
| starting_dose     =  
| preparations     = IR tablets 15, 30 mg; oral solution 10 mg/5 mL, 20 mg/mL, 100 mg/5 mL (concentrated); suppositories; ER tablets and capsules in multiple strengths; injectable 0.5-50 mg/mL
| preparations      =  
| fda_max          = No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals
| fda_max           =  
| pill_id           =
| routes             =  
| routes           = Oral, intravenous, intramuscular, subcutaneous, epidural, intrathecal, rectal
| onset             =  
| onset             = 5-10 minutes (IV); 30 minutes (oral IR); slower for ER and rectal
| duration           =  
| duration         = 3-5 hours (IR); 8-24 hours (ER); 12-24 hours (epidural / intrathecal)
| halflife           =
| halflife          = Morphine 2-4 hours; morphine-6-glucuronide active metabolite 2-4 hours (longer with renal impairment)<ref name="mscontin-label">FDA Prescribing Information, MS Contin (morphine sulfate extended-release), Purdue/Mallinckrodt, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/019516s058lbl.pdf</ref>
| bioavailability    =
| bioavailability   = ~25-40% (oral; extensive first-pass)<ref name="mscontin-label" />
| pregnancy         =  
| pregnancy        = Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.{{citation needed}}
| legal              =  
| legal             = [[USLegal:Schedule II|Schedule II controlled substance]] in US; WHO essential medicine<ref name="mscontin-label" />
| intro              =
| mechanism         = <vote slug="morphine-mech-claim">'''Prototype μ-opioid receptor agonist''', the natural reference compound from which all other opioid analgesics are characterized by relative potency. Metabolized predominantly by UGT2B7 glucuronidation to morphine-3-glucuronide (M3G, inactive at μ but possibly neuroexcitatory at high concentrations) and morphine-6-glucuronide (M6G, active μ agonist, more potent than parent morphine and renally eliminated, so accumulates in renal impairment to produce prolonged respiratory depression).</vote> Histamine release with IV bolus produces flushing and hypotension. Crucially, morphine is '''not''' CYP2D6-dependent (no metabolic activation step is needed, unlike codeine and hydrocodone), so analgesic efficacy is genotype-independent. The Schedule II status and the CDC opioid prescribing guidance shape current clinical use<ref name="mscontin-label" />.
| pharmacokinetics   =  
| pharmacodynamics  =  
| indications        =  
| dosing             =  
| effects            =  
| interactions      = <pharmaInteractions/>
| pregnancy_details  =
| monitoring         =  
| counseling        =  
| anecdotes          =
| seealso            =
| references        =  
}}
}}


{{PendellsCorner
{{PendellsCorner
| quote  = Sert&uuml;rner isolated her in 1804 and gave her the name of the god of sleep. She is the molecule that proved alkaloids existed; she is the prototype of every opioid that came after; she is the standard the modern pharmacopeia uses to measure the analgesic potency of newer cousins. Opium remembered itself in her, and the rest of the field is footnote.
| quote  = Opium is the archetypal medicine, and morphine is its essence. Morphine is the most powerful naturally occurring analgesic in the world, and the synthetics use opium as their precursor.
| volume = Poeia
| volume = Poeia
| voice  = curated paraphrase &mdash; replace with verbatim passage
| page  = 123
}}
}}


[[Category:Opioids]]
== References ==
<references />
 
[[Category:Opioid analgesics]]
[[Category:Schedule II controlled substances]]
[[Category:Analgesics]]
[[Category:Natural opioids]]
[[Category:Natural opioids]]
[[Category:Analgesics]]
[[Category:Mu-Opioid Receptor Agonists]]

Latest revision as of 07:07, 23 May 2026

Opioid analgesic (natural phenanthrene from opium poppy), Schedule II controlled substance, Analgesic
Morphine (sulfate)
MS Contin (ER), Kadian (ER), Avinza (ER), Roxanol (IR oral solution), Duramorph (epidural / IT), Astramorph (IV), Infumorph (intrathecal pump), MorphaBond (IR abuse-deterrent)

Experience

👥 No personal reports yet
⚕ No clinical reports yet

Log in to add your own experience.

Problems

No problems yet. Be the first to suggest one.

+ Add a problem

Titration strategies

No titration strategies yet. Be the first to suggest one.

+ Add a titration strategy

Effects

No effects listed yet. Be the first to suggest one.

+ Add an effect

Relevant anecdote

No anecdotes yet. Share a relevant one.

+ Add an anecdote

Relevant Literature

No literature entries yet.

Log in to submit relevant literature.

Summary
Classes
Opioid analgesic (natural phenanthrene from opium poppy), Schedule II controlled substance, Analgesic
Common uses
Moderate to severe acute pain (FDA)0, Severe chronic pain unresponsive to non-opioid alternatives (FDA, with CDC opioid prescribing guidance constraints)0, Cancer pain (FDA; the global gold standard, WHO essential medicine)0, Preoperative analgesia (FDA)0, Epidural and intrathecal pain management (FDA)0
Pharmacy
Starting dose
IR oral: 15-30 mg every 4 hours as needed. ER opioid-naive: 15-30 mg every 12 hours. IV/IM/SC: 2-10 mg every 3-4 hours. Epidural / intrathecal: see surgical or palliative-care protocols
Preparations
IR tablets 15, 30 mg; oral solution 10 mg/5 mL, 20 mg/mL, 100 mg/5 mL (concentrated); suppositories; ER tablets and capsules in multiple strengths; injectable 0.5-50 mg/mL
US FDA Max
No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals
Pharmacology
Routes
Oral, intravenous, intramuscular, subcutaneous, epidural, intrathecal, rectal
Onset
5-10 minutes (IV); 30 minutes (oral IR); slower for ER and rectal
Duration
3-5 hours (IR); 8-24 hours (ER); 12-24 hours (epidural / intrathecal)
Half-life
Morphine 2-4 hours; morphine-6-glucuronide active metabolite 2-4 hours (longer with renal impairment)[1]
Bioavailability
~25-40% (oral; extensive first-pass)[1]
Pregnancy
Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.[citation needed]
Legal status
Schedule II controlled substance in US; WHO essential medicine[1]
Purported mechanism
Prototype μ-opioid receptor agonist, the natural reference compound from which all other opioid analgesics are characterized by relative potency. Metabolized predominantly by UGT2B7 glucuronidation to morphine-3-glucuronide (M3G, inactive at μ but possibly neuroexcitatory at high concentrations) and morphine-6-glucuronide (M6G, active μ agonist, more potent than parent morphine and renally eliminated, so accumulates in renal impairment to produce prolonged respiratory depression).0 Histamine release with IV bolus produces flushing and hypotension. Crucially, morphine is not CYP2D6-dependent (no metabolic activation step is needed, unlike codeine and hydrocodone), so analgesic efficacy is genotype-independent. The Schedule II status and the CDC opioid prescribing guidance shape current clinical use[1].
“Pendell's corner
Opium is the archetypal medicine, and morphine is its essence. Morphine is the most powerful naturally occurring analgesic in the world, and the synthetics use opium as their precursor.
— Dale Pendell, Pharmako/Poeia, p. 123

References

  1. ↑ 1.0 1.1 1.2 1.3 FDA Prescribing Information, MS Contin (morphine sulfate extended-release), Purdue/Mallinckrodt, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/019516s058lbl.pdf
Retrieved from "https://pharmacopedia.wiki/index.php?title=Morphine&oldid=6686"