Morphine: Difference between revisions

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{{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 =

| 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

| ~~routes =~~

| pill_id =

~~| onset~~ =

| routes = Oral, intravenous, intramuscular, subcutaneous, epidural, intrathecal, rectal

| ~~duration~~ =

| onset = 5-10 minutes (IV); 30 minutes (oral IR); slower for ER and rectal

| ~~halflife~~ =

| duration = 3-5 hours (IR); 8-24 hours (ER); 12-24 hours (epidural / intrathecal)

| ~~bioavailability~~ =

| 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>

| ~~pregnancy~~ =

| bioavailability = ~25-40% (oral; extensive first-pass)<ref name="mscontin-label" />

| ~~legal~~ =

| pregnancy = Chronic third-trimester exposure produces neonatal opioid withdrawal syndrome and respiratory depression at delivery.{{citation needed}}

~~| intro~~ =

| legal = [[USLegal:Schedule II|Schedule II controlled substance]] in US; WHO essential medicine<ref name="mscontin-label" />

| ~~pharmacokinetics~~ =

| 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" />.

~~| pharmacodynamics~~ =

| ~~indications~~ =

| ~~dosing~~ =

| ~~effects~~ =

| ~~contraindications =~~

~~| interactions =~~

~~| pregnancy_details =~~

~~| monitoring~~ =

~~| counseling~~ =

~~| anecdotes =~~

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~~| references~~ =

}}

{{PendellsCorner

| 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

| page = 123

}}

== References ==

[[Category:Opioid analgesics]]

[[Category:Schedule II controlled substances]]

[[Category:Analgesics]]

[[Category:Natural opioids]]

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