Pharmacologic Class: Opioid receptor agonist
ACTIONS AND USES: Morphine binds with both mu and kappa receptor sites to produce profound analgesia. It causes euphoria, constriction of the pupils, and stimulation of cardiac muscle. It is used for symptomatic relief of serious acute and chronic pain after non-narcotic analgesics have failed, as pre-anesthetic medication, to relieve shortness of breath associated with heart failure and pulmonary edema, and for acute chest pain connected with MI.
ADMINISTRATION ALERTS: The oral solution may be given sublingually. The oral solution comes in multiple strengths; carefully observe drug orders and labels before administering. Morphine causes peripheral vasodilation, which results in orthostatic hypotension. Pregnancy category B (D in long-term use or with high doses).
ADVERSE EFFECTS: Morphine may cause dysphoria (restlessness, depression, and anxiety), hallucinations, nausea, constipation, dizziness, and an itching sensation. Overdose may result in severe respiratory depression or cardiac arrest. Tolerance develops to the sedative, nausea-producing, and euphoric effects of the drug. Cross-tolerance also develops between morphine and other opioids such as heroin, methadone, and meperidine.
Physical and psychological dependence develops when high doses are taken for prolonged periods.
Warning: When morphine is administered as an epidural drug, due to the risk of adverse effects, patients must be observed in a fully equipped and staffed environment for at least 24 hours. Morphine administered as extended-release tablets has an abuse liability similar to other opioid analgesics. Morphine is a Schedule II controlled substance and should be taken properly according to dispensing instructions (i.e., tablets/capsules should be taken whole and not broken, chewed, dissolved, or crushed). Alcohol should be avoided with morphine products. Failure to follow these warnings could result in fatal respiratory depression.
Contraindications: Morphine may intensify or mask the pain of gallbladder disease, due to biliary tract spasms. Morphine should also be avoided in cases of acute or severe asthma, GI obstruction, and severe hepatic or renal impairment.
INTERACTIONS: Drug–Drug: Morphine interacts with several drugs. For example, concurrent use of CNS depressants, such as alcohol, other opioids, general anesthetics, sedatives, and antidepressants such as monoamine oxidase (MAO) inhibitors and tricyclics, potentiate the action of opiates, increasing the risk of severe respiratory depression and death.
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