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Infumorph
morphine sulfate
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate associated risks; should only be administered by physicians familiar with patient management problems associated with epidural or intrathecal administration and should only be given where appropriate monitoring available; proper dosing and titration essential to decr. respiratory depression risk
Neuraxial Administration Risk
risk of severe adverse reactions including acute or delayed respiratory depression up to 24h with single-dose epidural or intrathecal administration; observe patients in fully equipped and staffed environment for at least 24h after initial dose and, as appropriate, for 1st several days after catheter implantation
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance with risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all patients for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even with recommended use, especially during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use with Benzodiazepines, CNS Depressants
concomitant opioid use with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death; reserve concomitant use for patients with inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
advise pregnant patients with extended opioid use of risk of potentially life-threatening neonatal opioid withdrawal syndrome; ensure tx by neonatology experts available at delivery
Adult Dosing .
Dosage forms: INJ
pain, moderate-severe chronic
- [epidural route, opioid non-tolerant patients]
- Dose: individualize dose via epidural continuous infusion; Start: 3.5-7.5 mg/day epidural continuous infusion; Info: do not use for initial bolus test dose; use lowest effective dose, shortest effective tx duration; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
- [epidural route, opioid tolerant patients]
- Dose: individualize dose via epidural continuous infusion; Start: 4.5-10 mg/day epidural continuous infusion; Info: do not use for initial bolus test dose; use lowest effective dose, shortest effective tx duration; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
- [intrathecal route, opioid non-tolerant patients]
- Dose: individualize dose via intrathecal continuous infusion; Start: 0.2-1 mg/day intrathecal continuous infusion; Info: do not use for initial bolus test dose; epidural administration preferred; use lowest effective dose, shortest effective tx duration; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
- [intrathecal route, opioid tolerant patients]
- Dose: individualize dose via intrathecal continuous infusion; Start: 1-10 mg/day intrathecal continuous infusion; Info: do not use for initial bolus test dose; epidural administration preferred; use lowest effective dose, shortest effective tx duration; taper dose gradually to avoid withdrawal symptoms if D/C tx in physically opioid-dependent patients; search 'opioid taper' for epocrates Opioid Tapering decision tool
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- cirrhosis: decr. usual start dose, amount not defined; Info: titrate slowly
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.