morphine sulfate
Astramorph PF, Avinza, DepoDur,
Duramorph, Epimorph (CAN), Kadian,
M-Eslon (CAN), Morphine Extra-Forte
(CAN), Morphine Forte (CAN), Morphine
H.P. (CAN), Morphitec (CAN), MS Contin,
MSIR, MS/L, MS/L Concentrate, MS/S,
OMS Concentrate, Oramorph SR,
Rescudose, RMS Uniserts, Roxanol,
Roxanol 100, Roxanol UD, Statex (CAN)
Nursing Considerations
• Use cautiously in patients about to undergo
surgery of the biliary tract and patients
with acute pancreatitis secondary to biliary
tract disease because morphine may
cause spasm of the sphincter of Oddi.
• Store morphine at room temperature.
• Before giving morphine, make sure opioid
antagonist and equipment for oxygen
delivery and respiration are available.
• Before therapy, assess patient’s drug use,
including all prescription and OTC drugs.
• Expect prescriber to start patient who has
never received opioids on immediaterelease
form and then switch to E.R. form
if therapy must last longer than a few days.
• Keep in mind that when morphine is
given by epidural route, dosage must be
individualized according to patient’s age,
body mass, physical status, previous experience
with opioids, risk factors for respiratory
depression, and drugs to be coadministered
before or during surgery.
• Give oral form with food or milk to minimize
adverse GI reactions, if needed.
Solution can be mixed with fruit juice to
improve taste.
• If needed, open E.R. capsules and sprinkle
contents on applesauce (at room temperature
or cooler) just before giving to
patient. Make sure patient doesn’t chew or
crush capsules or dissolve capsule’s pellets
in his mouth.
• Be aware that E.R. forms of morphine
aren’t interchangeable.
• Discard injection solution that is discolored
or darker than pale yellow or that
contains precipitates that don’t dissolve
with shaking.
WARNING Don’t use highly concentrated
solutions (such as 10 to 25 mg/ml) for single-
dose I.V., I.M., or subcutaneous
administration. These solutions are
intended for use in continuous, controlled
microinfusion devices.
• For direct I.V. injection, dilute appropriate
dose with 4 to 5 ml of sterile water for
injection. Inject 2.5 to 15 mg directly into
tubing of free-flowing I.V. solution over 4
to 5 minutes. Rapid I.V. injection may
increase adverse reactions.
• For continuous I.V. infusion, dilute drug
in D5W and administer with infusioncontrol
device. Adjust dose and rate based
on patient response, as prescribed.
• Avoid I.M. route for long-term therapy
because of injection site irritation.
• During subcutaneous injection, take care
to avoid injecting drug intradermally.
• For intrathecal injection, expect prescriber
to give no more than 2 ml of 0.5-mg/ml
solution or 1 ml of 1-mg/ml solution.
Expect intrathecal dosage to be about onetenth
of epidural dosage.
• If rectal suppository is too soft to insert,
refrigerate for 30 minutes or run wrapped
suppository under cold tap water.
WARNING Monitor respiratory and cardio-
vascular status carefully and frequently
during morphine therapy. Be alert for respiratory
depression and hypotension.
•Monitor patient with seizure disorder for
increased seizure activity because morphine
may worsen the disorder.
•Monitor patient for excessive or persistent
sedation; dosage may need to be adjusted.
• If patient is receiving a continuous morphine
infusion, watch for and notify prescriber
about new neurologic signs or
symptoms. Inflammatory masses (such as
granulomas) have caused serious neurologic
reactions, including paralysis.
• Expect morphine to cause physical and
psychological dependence; watch for drug
tolerance and withdrawal, such as body
aches, diaphoresis, diarrhea, fever, piloerection,
rhinorrhea, sneezing, and yawning.
• If tolerance to morphine develops, expect
prescriber to increase dosage.
•Morphine may have a prolonged duration
and cumulative effect in patients with
impaired hepatic or renal function. It also
may prolong labor by reducing strength,
duration, and frequency of uterine contractions.
•When discontinuing morphine in patients
receiving more than 30 mg daily, expect
prescriber to reduce daily dose by about
one-half for 2 days and then by 25% every
2 days thereafter until total dose reaches
initial amount recommended for patients
who haven’t received opioids (15 to 30 mg
daily). This regimen minimizes the risk of
withdrawal symptoms.
PATIENT TEACHING
• Instruct patient to take morphine exactly
as prescribed and not to change dosage
without consulting prescriber.
• Explain that patient may take tablets or
capsules with food or milk to relieve GI
distress and may mix oral solution with
juice to improve taste.
• Urge patient not to break, chew, or crush
E.R. capsules and tablets to avoid rapid
release and, possibly, toxicity.
• For patient who has difficulty swallowing,
suggest that he open E.R. capsules and
sprinkle contents on food or liquids. Urge
him to take drug immediately and not let
capsule contents dissolve in his mouth.
• Instruct patient to moisten rectal suppository
before inserting it.
• Urge patient to avoid alcohol and other
CNS depressants during therapy.
• Advise patient to avoid potentially hazardous
activities during morphine therapy.
• Tell patient to change positions slowly to
minimize the orthostatic hypotension.
• Instruct patient to notify prescriber about
worsening or breakthrough pain.
• Explain that morphine may be habitforming.
Urge him to notify prescriber if
he experiences anxiety, decreased appetite,
excessive tearing, irritability, muscle aches
or twitching, rapid heart rate, or yawning.
• Advise female patient to notify prescriber
if she becomes pregnant. Regular morphine
use during pregnancy may cause
physical dependence in fetus and withdrawal
in neonate.
