Mastodon

Morphine (Tablets, Capsules, Solution, Drops) Instructions for Use

ATC Code

N02AA01 (Morphine)

Active Substance

Morphine (BAN)

Clinical-Pharmacological Group

Pure opioid receptor agonist. Analgesic

Pharmacotherapeutic Group

Analgesics; opioids; natural opium alkaloids

Pharmacological Action

Opioid analgesic, agonist of opioid receptors. It has a pronounced analgesic effect. By reducing the excitability of pain centers, it has an anti-shock effect. In high doses, it causes a hypnotic effect. It inhibits conditioned reflexes, reduces the excitability of the cough center and causes excitation of the vagus nerve center, which leads to bradycardia.

It increases the tone of the smooth muscles of internal organs (including the bronchi), as well as the sphincters of the gastrointestinal tract, biliary tract and urinary bladder. It reduces secretory activity in the gastrointestinal tract, lowers basal metabolism and body temperature. It depresses the respiratory center. It stimulates the release of ADH.

Vomiting, which can sometimes be observed with the use of morphine, is associated with the excitation of the chemoreceptor trigger zones of the medulla oblongata, which activate the vomiting center. However, as a rule, Morphine has a depressant effect on the vomiting center, therefore the use of morphine in repeated doses and emetics administered after morphine does not cause vomiting.

The effect develops 20-30 minutes after oral administration and 10-15 minutes after subcutaneous injection.

Pharmacokinetics

Morphine is rapidly absorbed after oral administration and subcutaneous injection. After oral administration, absorption is 70-80%. Morphine undergoes a first-pass effect through the liver, it is metabolized in the liver mainly by conjugation with glucuronides.

T1/2 is 2-3 hours. It is excreted as metabolites mainly by the kidneys – 90%, the remainder – with bile. Less than 10% is excreted unchanged.

In elderly patients, an increase in T1/2 is possible.

In case of impaired liver or kidney function, T1/2 increases.

Indications

Severe pain syndrome in severe diseases and injuries, including malignant neoplasms, myocardial infarction; for preoperative preparation and in the postoperative period; cough not relieved by antitussive drugs; severe shortness of breath due to acute cardiovascular failure.

ICD codes

ICD-10 code Indication
I50.1 Left ventricular failure
R05 Cough
R52.0 Acute pain
R52.2 Other chronic pain
Z51.4 Preparatory procedures for subsequent treatment or examination, not elsewhere classified
ICD-11 code Indication
BD11.Z Left ventricular failure, unspecified
MD12 Cough
MG30.Z Chronic pain syndrome, unspecified
MG31.Z Acute pain, unspecified
QB9A Preparatory procedures for subsequent treatment

Dosage Regimen

The method of application and dosage regimen for a specific drug depend on its form of release and other factors. The optimal dosage regimen is determined by the doctor. It is necessary to strictly adhere to the compliance of the dosage form of a specific drug with the indications for use and dosage regimen.

Determine the dose and route of administration individually based on pain severity, clinical situation, and patient response.

For adults, initiate oral therapy with 5-20 mg every 4 hours as needed for pain.

Titrate the dose gradually to achieve adequate analgesia while managing adverse effects.

For severe, chronic pain, use modified-release formulations to provide stable analgesia; administer every 12 or 24 hours.

For subcutaneous, intramuscular, or slow intravenous injection, a typical adult dose is 2.5-15 mg every 4 hours.

Administer intravenous injections slowly over 4-5 minutes.

For pediatric patients over 2 years of age, calculate the oral dose as 0.2-0.5 mg/kg every 4-6 hours.

Calculate the parenteral dose for children as 0.1-0.2 mg/kg every 4 hours as needed.

In elderly or debilitated patients, initiate therapy at the lower end of the dosing range.

Reduce the dose in patients with renal impairment or hepatic impairment.

Monitor patients closely for signs of respiratory depression, especially during initiation and dose titration.

For patients switching from parenteral morphine, note that the oral dose is approximately 2-3 times the parenteral dose due to first-pass metabolism.

To discontinue long-term therapy, taper the dose gradually to prevent withdrawal symptoms.

Adverse Reactions

From the cardiovascular system bradycardia, decreased blood pressure.

From the digestive system dyspepsia, nausea, vomiting, constipation; cholestasis in the main bile duct.

From the nervous system: headache, dizziness, sedative or stimulating effect, hallucinations, delirium, increased intracranial pressure, impaired cerebral circulation, fainting, drowsiness, taste perversion, paresthesia; very rarely – tremor, convulsions, especially with epidural administration.

From the respiratory system respiratory depression, bronchospasm.

From the urinary system impaired urine outflow or worsening of this condition in prostate adenoma and urethral stenosis.

From the reproductive system amenorrhea, decreased libido, erectile dysfunction.

Allergic reactions facial hyperemia, skin rash.

Local reactions with parenteral use – hyperemia, swelling, burning at the injection site.

Other sweating, decreased appetite, peripheral edema, asthenia, weakness, chills; frequency unknown – habituation and dependence.

Contraindications

General severe exhaustion, respiratory impairment due to depression of the respiratory center, severe abdominal pain of unclear etiology, severe hepatocellular failure, brain injury, intracranial hypertension, status epilepticus, acute alcohol intoxication, delirium, children under 2 years of age, simultaneous use of MAO inhibitors.

With caution bronchial asthma attack, COPD, arrhythmias, convulsions, drug abuse or drug dependence, including dependence on opioids (including history), alcoholism, suicidal tendency, emotional lability, cholelithiasis, surgical interventions on the gastrointestinal tract, urinary system, brain injury, intracranial hypertension, hepatic or renal failure, hypothyroidism, severe inflammatory bowel diseases, prostate hyperplasia, urethral strictures, paralytic ileus, conditions after surgical intervention on the biliary tract, pulmonary heart failure against the background of chronic lung diseases; pregnancy, breastfeeding period; old age.

Use in Pregnancy and Lactation

During pregnancy, childbirth and the breastfeeding period, the use of morphine is permissible only for vital indications (development of drug dependence in the fetus and newborn is possible).

Use in Hepatic Impairment

Contraindicated in severe hepatocellular failure.

Use in Renal Impairment

Should be used with caution in patients with impaired renal function.

Pediatric Use

Contraindicated for use in children under 2 years of age.

Geriatric Use

Used with caution in elderly patients.

Special Precautions

Use with caution in elderly and senile patients. It is necessary to assess the specific sensitivity to the analgesic effect, the effect on the central nervous system (confusion) and the gastrointestinal tract, as well as the physiological decrease in renal function. In particular, caution should be exercised when prescribing the initial dose.

Morphine causes pronounced euphoria; with repeated subcutaneous administration, drug dependence develops rapidly; with regular oral administration of a therapeutic dose, dependence can develop within 2-14 days from the start of treatment. Withdrawal syndrome can occur several hours after discontinuation of a long course of treatment and reach a maximum after 36-72 hours.

All patients receiving opioid analgesics require special monitoring; there is a risk of developing drug dependence even with adequate medical use.

In patients with planned heart surgery or other surgery with intense postoperative pain syndrome, the use of morphine should be stopped 24 hours before surgery. If therapy is subsequently indicated, the dosage regimen is chosen taking into account the severity of the surgery.

If nausea and vomiting occur, a combination of morphine with phenothiazine can be used.

In case of compensated respiratory failure, it is necessary to carefully monitor the respiratory rate. Drowsiness is a warning sign of decompensation.

It is important to reduce the dose of morphine when other centrally acting analgesics are prescribed simultaneously, as in this case there is a risk of sudden respiratory arrest.

Morphine should be prescribed with caution to patients with impaired liver function, clinical monitoring is required.

In the presence of prostate and bladder diseases, there is a risk of urinary retention.

To reduce the side effects of morphine preparations on the intestines (constipation), systematic prophylactic treatment is necessary, laxatives should be used.

Concomitant use of drugs that have a depressant effect on the central nervous system (antihistamines, hypnotics, psychotropic drugs, anticholinergics, other analgesics) increases the risk of side effects; their use is allowed only with the permission and under the supervision of a doctor.

After sudden discontinuation of a long course of use, after a few hours, a withdrawal syndrome may develop, characterized by the following symptoms: anxiety, irritability, chills, dilated pupils, hot flashes, sweating, lacrimation, runny nose, nausea, vomiting, abdominal pain, diarrhea, joint pain, maximum manifestations are possible after 36-72 hours.

Withdrawal syndrome can be prevented by gradual dose reduction.

The use of morphine may give positive results in a doping test.

Do not consume alcohol during use.

Effect on the ability to drive vehicles and mechanisms

During the treatment period, patients should refrain from driving vehicles and other activities that require high concentration and speed of psychomotor reactions.

Drug Interactions

With simultaneous use, the effect of hypnotics and sedatives, agents for general and local anesthesia, anxiolytics is enhanced.

Pronounced depression of the central nervous system, developing with simultaneous use of barbiturates and narcotic analgesics, sometimes leads to respiratory depression and the development of arterial hypotension.

With systematic use of barbiturates, especially phenobarbital, there is a possibility of a decrease in the analgesic effect of opioid analgesics. Long-term use of barbiturates or opioid analgesics stimulates the development of cross-tolerance.

There are reports of an increase in the clearance of morphine with simultaneous use of oral hormonal contraceptives.

With simultaneous use with MAO inhibitors, undesirable manifestations of drug interaction from the cardiovascular system are possible.

With simultaneous use with phenothiazine derivatives, an increase in the analgesic, hypotensive effects, as well as respiratory depression caused by morphine is possible.

With simultaneous use of amitriptyline, doxepin, chlorpromazine, haloperidol, indomethacin, naproxen, piroxicam, acetylsalicylic acid with morphine in high doses in patients with cancer, cases of myoclonus have been described.

With simultaneous use with dopamine, a decrease in the analgesic effect of morphine is possible; with ketamine – potentiation of the depressant effect of morphine on the respiratory center; with ketoprofen – reduction of respiratory depression due to the action of morphine; with lidocaine – an increase in the analgesic effect of morphine is possible.

Morphine weakens the effect of hymecromone.

With simultaneous use with mexiletine, a decrease in the absorption of mexiletine is possible; with methylphenidate – an increase in the analgesic effect of morphine and a decrease in its sedative effect; with metoclopramide – the rate of absorption of morphine when taken orally increases and the sedative effect is enhanced.

With simultaneous use, naloxone and nalorphine eliminate analgesia and respiratory depression caused by morphine.

With simultaneous use with pancuronium bromide, an increase in blood pressure is possible; with propranolol – an increase in the depressant effect on the central nervous system caused by morphine; with rifampicin – an increase in the excretion of morphine and a significant decrease in its effectiveness is possible; with phenylbutazone – accumulation of morphine is possible.

With simultaneous use with fluoxetine, an increase in the analgesic effect of morphine is possible, dizziness and nausea are reduced.

With simultaneous use with cimetidine, an increase in the depressant effect of morphine on respiration is possible.

With simultaneous use with chlorpromazine, the miotic, sedative, and analgesic effects of morphine are enhanced; cases of myoclonus have been described.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.

Medical Disclaimer

Brand (or Active Substance), Marketing Authorisation Holder, Dosage Form

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Film-coated tablets, 5 mg: 20 pcs.

Dosage Form, Packaging, and Composition

Film-coated tablets white, round, biconvex, on the cross-section – a core of white or almost white color.

1 tab.
Morphine hydrochloride trihydrate 5 mg

Excipients : potato starch – 13.2 mg, lactose monohydrate type 100 – 45.5 mg, microcrystalline cellulose type 102 – 58.5 mg, povidone type K-17 – 3.9 mg, sodium carboxymethyl starch (type A) – 2.6 mg, magnesium stearate – 1.3 mg.

Film coating composition mixture VIVACOAT®PA-1P-000, including hypromellose 6 (E464) – 1.95 mg, titanium dioxide (E171), polydextrose (E1200) – 0.75 mg, talc (E553b) – 0.5 mg, polyethylene glycol 3350 (E1521) – 0.3 mg.

10 pcs. – contour cell packaging (2) – cardboard packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Injection solution 10 mg/1 ml: 1 ml amp. 5 or 10 pcs.

Dosage Form, Packaging, and Composition

Solution for injection in the form of a transparent, colorless or slightly yellowish liquid.

1 ml
Morphine hydrochloride trihydrate 10 mg,
   Equivalent to morphine hydrochloride content 8.56 mg

Excipients : disodium edetate – 0.2 mg, hydrochloric acid solution 0.1M – to pH from 3.0 to 4.0, water for injection – up to 1 ml.

1 ml – glass ampoules (5) – contour cell packaging (1) – cardboard packs.
1 ml – glass ampoules (5) – contour cell packaging (2) – cardboard packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Solution for subcutaneous injection 10 mg/1 ml: syringe-tubes 20, 50 or 100 pcs.

Dosage Form, Packaging, and Composition

Solution for subcutaneous administration 1 ml
Morphine hydrochloride 10 mg

1 ml – syringe-tubes (100) – cardboard boxes.
1 ml – syringe-tubes (20) – cardboard boxes.
1 ml – syringe-tubes (50) – cardboard boxes.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Film-coated tablets 10 mg: 20 pcs.

Dosage Form, Packaging, and Composition

Film-coated tablets pink, round, biconvex, on the cross-section – a core of white or almost white color.

1 tab.
Morphine hydrochloride trihydrate 10 mg

Excipients : potato starch – 13.2 mg, lactose monohydrate type 100 – 45.5 mg, microcrystalline cellulose type 102 – 53.5 mg, povidone type K-17 – 3.9 mg, sodium carboxymethyl starch (type A) – 2.6 mg, magnesium stearate – 1.3 mg.

Film coating composition mixture VIVACOAT®PA-3P-255, including hypromellose 6 (E464) – 1.95 mg, titanium dioxide (E171) – 1.6 mg, polydextrose (E1200) – 0.3 mg, talc (E553b) – 0.395 mg, polyethylene glycol 3350 (E1521) – 0.3 mg, dye iron oxide red (E172) – 0.005 mg.

10 pcs. – contour cell packaging (2) – cardboard packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Forms

Bottle Rx Icon Morphine Oral solution 2 mg/ml: amp. 5 ml 20 pcs.
Oral solution 6 mg/ml: amp. 5 ml 20 pcs.
Oral solution 20 mg/ml: amp. 5 ml 20 pcs.

Dosage Form, Packaging, and Composition

Oral solution as a clear, colorless or slightly yellowish liquid.

1 ml
Morphine hydrochloride trihydrate 2 mg

Excipients: disodium edetate – 0.1 mg, citric acid monohydrate – 7 mg, purified water – up to 1 ml.

5 ml – ampoules (20) – carton packs.


Oral solution as a clear, colorless or slightly yellowish liquid.

1 ml
Morphine hydrochloride trihydrate 6 mg

Excipients: disodium edetate – 0.1 mg, citric acid monohydrate – 7 mg, purified water – up to 1 ml.

5 ml – polymer ampoules (20) – carton packs.


Oral solution as a clear, colorless or slightly yellowish liquid.

1 ml
Morphine hydrochloride trihydrate 20 mg

Excipients: disodium edetate – 0.1 mg, citric acid monohydrate – 7 mg, purified water – up to 1 ml.

5 ml – ampoules (20) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Oral drops 20 mg/ml: 10 ml bottle 2 pcs.

Dosage Form, Packaging, and Composition

Oral drops as a clear, colorless or slightly yellowish liquid.

1 ml
Morphine hydrochloride trihydrate 20 mg

Excipients: disodium edetate – 0.1 mg, citric acid monohydrate – 7 mg, sodium benzoate – 1 mg, purified water – up to 1 ml.

10 ml – light-protective glass bottles (2) with dropper caps – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Long Extended-release tablets 10 mg: 20 pcs.

Dosage Form, Packaging, and Composition

Extended-release tablets light brown in color, round, biconvex, with a white or almost white core on the cross-section.

1 tab.
Morphine hydrochloride trihydrate 10 mg

Excipients: hypromellose (hydroxypropyl methylcellulose) type K 100 LV – 50 mg, lactose monohydrate type 100 – 40 mg, microcrystalline cellulose type 102 – 96 mg, colloidal silicon dioxide – 2 mg, magnesium stearate – 2 mg.
The mass of the uncoated tablet is 200 mg.
Film coating composition*
ready-made mixture OPADRY® II BROWN 85F265092, including polyvinyl alcohol (E 1203) – 2.4 mg, polyethylene glycol 4000 (E 1521) – 1.212 mg, talc (E 553b) – 0.888 mg, titanium dioxide (E171) – 1.11 mg, iron oxide yellow (E172) – 0.33 mg, iron oxide red (E172) – 0.06 mg.
*either the ready-made mixture OPADRY® II or a mixture of substances prepared during the manufacturing process may be used in production.
The mass of the coated tablet is 206 mg.

10 pcs. – contour cell packaging (2) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Long Extended-release tablets 30 mg: 20 pcs.

Dosage Form, Packaging, and Composition

Extended-release tablets purple-pink in color, round, biconvex, with a white or almost white core on the cross-section.

1 tab.
Morphine hydrochloride trihydrate 30 mg

Excipients: hypromellose (hydroxypropyl methylcellulose) type K 100 LV – 44 mg, lactose monohydrate type 100 – 52 mg, microcrystalline cellulose type 102 – 70 mg, colloidal silicon dioxide – 2 mg, magnesium stearate – 2 mg.
The mass of the uncoated tablet is 200 mg.
Film coating composition*
ready-made mixture OPADRY® II PURPLE 85F200020, including polyvinyl alcohol (E 1203) – 2.4 mg, polyethylene glycol 4000 (E 1521) – 1.212 mg, talc (E 553b) – 0.888 mg, titanium dioxide (E171) – 1.418 mg, iron oxide black (E172) – 0.027 mg, Ponceau 4R (E124) – 0.055 mg.
*either the ready-made mixture OPADRY® II or a mixture of substances prepared during the manufacturing process may be used in production.
The mass of the coated tablet is 206 mg

10 pcs. – contour cell packaging (2) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Long Extended-release tablets 60 mg: 20 pcs.

Dosage Form, Packaging, and Composition

Extended-release tablets orange in color, oval, biconvex, with a white or almost white core on the cross-section.

1 tab.
Morphine hydrochloride trihydrate 60 mg

Excipients: hypromellose (hydroxypropyl methylcellulose) type K 750 PH – 165 mg, lactose monohydrate type 100 – 259 mg, microcrystalline cellulose type 102 – 55 mg, colloidal silicon dioxide – 5.5 mg, magnesium stearate – 5.5 mg.
The mass of the uncoated tablet is 550 mg.
Film coating composition*
ready-made mixture OPADRY® II ORANGE 85F230062, including polyvinyl alcohol (E 1203) – 6.8 mg, polyethylene glycol 4000 (E 1521) – 3.434 mg, talc (E 553b) – 2.516 mg, titanium dioxide (E171) – 3.621 mg, iron oxide yellow (E172) – 0.119 mg, sunset yellow FCF – 0.51 mg.
*either the ready-made mixture OPADRY® II or a mixture of substances prepared during the manufacturing process may be used in production.
The mass of the coated tablet is 567 mg.

10 pcs. – contour cell packaging (2) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine Long Extended-release tablets 100 mg: 20 pcs.

Dosage Form, Packaging, and Composition

Extended-release tablets gray in color, oval, biconvex, with a white or almost white core on the cross-section.

1 tab.
Morphine hydrochloride trihydrate 100 mg

Excipients: hypromellose (hydroxypropyl methylcellulose) type K 4M – 192 mg, lactose monohydrate type 100 – 216 mg, microcrystalline cellulose type 102 – 80 mg, colloidal silicon dioxide – 6 mg, magnesium stearate – 6 mg.
The mass of the uncoated tablet is 600 mg.
Film coating composition*
ready-made mixture OPADRY® II GREY 85F275017, including polyvinyl alcohol (E 1203) – 7.2 mg, polyethylene glycol 4000 (E 1521) – 3.636 mg, talc (E 553b) – 2.664 mg, titanium dioxide (E171) – 4.295 mg, iron oxide yellow (E172) – 0.045 mg, iron oxide black (E172) – 0.16 mg.
*either the ready-made mixture OPADRY® II or a mixture of substances prepared during the manufacturing process may be used in production.
The mass of the coated tablet is 618 mg.

10 pcs. – contour cell packaging (2) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Manufactured By

Ethypharm (France)

Labeled By

MOSCOW ENDOCRINE PLANT FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine sulfate Extended-release capsules 10 mg: 10, 20, or 50 pcs.

Dosage Form, Packaging, and Composition

Extended-release capsules 1 caps.
Morphine 10 mg

10 pcs. – contour cell packaging (1) – carton packs.
10 pcs. – contour cell packaging (2) – carton packs.
10 pcs. – contour cell packaging (5) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Manufactured By

Ethypharm (France)

Labeled By

MOSCOW ENDOCRINE PLANT FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine sulfate Extended-release capsules 30 mg: 10, 20, or 50 pcs.

Dosage Form, Packaging, and Composition

Extended-release capsules 1 caps.
Morphine 30 mg

10 pcs. – contour cell packaging (1) – carton packs.
10 pcs. – contour cell packaging (2) – carton packs.
10 pcs. – contour cell packaging (5) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Manufactured By

Ethypharm (France)

Labeled By

MOSCOW ENDOCRINE PLANT FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine sulfate Extended-release capsules 60 mg: 10, 20, or 50 pcs.

Dosage Form, Packaging, and Composition

Extended-release capsules 1 caps.
Morphine 60 mg

10 pcs. – contour cell packaging (1) – carton packs.
10 pcs. – contour cell packaging (2) – carton packs.
10 pcs. – contour cell packaging (5) – carton packs.

Marketing Authorization Holder

Moscow Endocrine Plant FSUE (Russia)

Manufactured By

Ethypharm (France)

Labeled By

MOSCOW ENDOCRINE PLANT FSUE (Russia)

Dosage Form

Bottle Rx Icon Morphine sulfate Extended-release capsules 100 mg: 10, 20, or 50 pcs.

Dosage Form, Packaging, and Composition

Extended-release capsules 1 caps.
Morphine 100 mg

10 pcs. – contour cell packaging (1) – carton packs.
10 pcs. – contour cell packaging (2) – carton packs.
10 pcs. – contour cell packaging (5) – carton packs.

Table of Contents

TABLE OF CONTENTS