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Morphine Intravenous for Adults
Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- In GUH, morphine is usually given by the subcutaneous route at ward level
- Morphine is used intravenously at ward level as Patient Controlled Analgesia (PCA)
- In GUH, it is generally in Critical Care areas that it is given by the intravenous route
- All morphine preparations stocked are controlled drugs
- For Y-site compatibility see below
Available preparations
Drug | Strength | Stocked in |
Morphine Sulphate | 1mg per 1ml ampoule (Preservative free) (Martindale brand) | Preferred product when Morphine 1mg preservative-free is required |
---|---|---|
Morphine HYDROCHLORIDE | 1mg per 1ml ampoule (Preservative free) Martindale brand) | Gynae, Labour Ward and Major Theatres - only when preferred product (above) is not available |
Morphine Sulphate | 1mg per 1ml ampoule (Preservative free) (South Devon Healthcare brand) | Neo-natal ICU ward only - when preferred product (above) is not available |
Morphine Sulphate | 10mg per 1ml ampoule | All areas |
Morphine Sulphate | 30mg per 1ml ampoule (for use in infusion only) | On request only in specific circumstances |
Morphine Sulphate | 60mg per 1ml ampoule (for use in infusion only) | Critical care areas and other areas if PCA bags in short supply |
Morphine Sulphate | 100mg in 100ml PCA bags | Critical care, surgical wards, X-ray |
Reconstitution
Already in solution
Draw up using a 5 micron filter needle (ampoules)
Infusion fluids
Sodium chloride 0.9%
Glucose 5%
Methods of intravenous administration
Slow intravenous injection
- Dilute to a convenient volume: suggest draw up 1ml (10mg) and dilute with 9ml Sodium chloride 0.9% to produce a 1mg per 1ml injection solution
- Administer required dose over 4 to 5 minutes (ref 1)
- Maximum rate of administration: 1 to 2mg per minute (ref 2)
Continuous intravenous infusion
- See 'Patient Controlled Analgesia (PCA) for Adult Patients' on Q-Pulse CLN-NM-047
- For critical care areas- dilute with infusion fluid as per CIS
Dose in adults
- See individual policies
- Use 10mg/ml strength ampoules only for all the indications below (to reduce risk of overdose)
- The higher strength ampoules are used in the preparation of infusions
Acute pain
- Give 5mg every four hours, adjusted according to response. Dose can be given more frequently during titration.
- Elderly and frail patients: Reduced dose recommended
Myocardial infarction (ref 2)
- Usual dose: give 5 to 10mg, followed by 5 to 10mg if required
- Elderly or frail patients: give 2.5 to 5mg, followed by 2.5 to 5mg if required
Acute pulmonary oedema (ref 2)
- Usual dose: Usual dose: give 5 to 10mg
- Elderly or frail patients: give 2.5 to 5mg
Renal impairment
- Avoid or use reduced dose in moderate to severe renal impairment (opioid effects increased, and prolonged and increased cerebral sensitivity occurs)
Hepatic impairment
- Use with caution as metabolised by the liver
Monitoring
- Monitor blood pressure, heart and respiratory rate (ref 1)
- Monitor the patient for one hour post dose if this is their first dose of morphine (ref 1)
Storage
Store in controlled drug cupboard below 25°C
References
1. Injectable Medicines Guide Medusa, downloaded 12/01/22
2. BNF- via Medicinescomplete 12/01/22
Therapeutic classification
Opioid analgesic
IV Guide Type