Morphine Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

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

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

Already in solution

Draw up using a 5 micron filter needle (ampoules)

Sodium chloride 0.9%

Glucose 5%

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

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)}

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

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)}

Store in controlled drug cupboard below 25⁰C

1. Injectable Medicines Guide Medusa, downloaded 12/01/22

2. BNF- via Medicinescomplete 12/01/22

Opioid analgesic