Select a medication above to begin.
Duramorph
morphine sulfate
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; epidural and intrathecal use should only be admin. by physicians familiar w/ patient management problems assoc. w/ epidural and intrathecal admin. and should only be given where appropriate monitoring available; reserve opioid analgesics for pts w/ inadequate tx alternatives; proper dosing and titration essential to decr. resp. depression risk
Neuraxial Administration Risk
risk of severe adverse rxns incl. acute or delayed resp. depression up to 24h w/ single-dose epidural or intrathecal admin; observe pts in fully equipped and staffed environment for at least 24h after initial dose
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ 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 pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately; rapid IV admin. may result in overdosing due to 30 min delay in max CNS effect w/ IV admin.
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Adult Dosing .
Dosage forms: INJ
pain, mod-severe
- [IV route]
- Dose: individualize dose IV prn; Start: 2-10 mg IV x1; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged use
- [epidural route]
- Dose: individualize dose epidurally prn; Start: 5 mg epidurally x1, then after 1h may give 1-2 mg/dose prn; Max: 10 mg/24h; Info: use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C if prolonged use
- [intrathecal route]
- Dose: 0.2-1 mg intrathecally x1; Info: epidural route preferred to intrathecal route; use lowest effective dose, shortest effective tx duration; if additional dose needed, consider alternate route; taper dose gradually to D/C if prolonged use
renal dosing
- [IV route]
- CrCl 10-50: decr. usual dose by 25%; CrCl <10: avoid use
- HD/PD: avoid use
- [epidural/intrathecal route]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.