Mor 10 Syrup
Morphine Sulphate
10mg
National Healthcare Pvt. Ltd.
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Available as:
Indications
Mor 10 Syrup is used for:
Pain, MI, Unstable angina, Intractable cough, Acute pulmonary oedema, Analgesia during labour
Adult Dose
Oral
Moderate to severe pain
Adult: 5-20 mg 4 hrly. Extended-release: 5-20 mg 12 hrly. Dosage is dependent on the severity of pain.
Intravenous
Pain associated with myocardial infarction
Adult: 5-10 mg at 1-2 mg/min followed by a further 5-10 mg as necessary.
Acute pulmonary oedema
Adult: 5-10 mg via slow inj at 2 mg/min.
Elderly: Half of the usual adult dose.
Parenteral
Moderate to severe pain
Adult: IM/SC: 5-20 mg; 2.5-10 mg via slow IV inj over 4-5 min w/ patient in recumbent position or a starting dose of 1-2 mg/hr via continuous IV infusion (max: 100 mg/day; 4 g/day in cancer patients). Doses may be adjusted according to severity of pain and patient's response.
Intraspinal
Moderate to severe pain
Adult: Initially, 5 mg epidural inj; after 1 hr, additional doses of 1-2 mg may be given up to a total dose of 10 mg/24 hr if pain relief is unsatisfactory. A dose of 20-30 mg daily may be required in some patients. Liposomal inj: 10-20 mg depending on the type of surgery.
Intrathecal
Moderate to severe pain
Adult: 0.2-1 mg once daily or 1-10 mg daily for patients w/ opioid tolerance. Some patients may require a dose of up to 20 mg daily.
Parenteral
Premedication in surgery
Adult: IM/SC: Up to 10 mg given 60-90 min before operation.
Hepatic impairment: Dosage may need to be reduced.
Child Dose
Analgesia/Cyanotic Tetralogy of Fallot
Neonates (<30 days): 0.3-1.2 mg/kg/day IM/SC divided q4hr; 0.005-0.03 mg/kg/hr slow IV
Infants and children (PO solution): 0.2-0.5 mg/kg PO q4-6hr PRN
Infants and children (IM/SC): 0.05-0.2 mg/kg q2-4hr PRN; not to exceed 15 mg/dose
Pain
Continuous infusion: 0.025-2.6 mg/kg/hr IV; average, 0.06 mg/kg/hr
Neonates (<30 days): 0.01-0.02 mg/kg/hr by IV infusion
Postoperative pain: 0.01-0.04 mg/kg/hr by IV infusion
Sickle-cell disease, cancer: 0.04-0.07 mg/kg/hr by IV infusion
Renal Dose
Renal impairment: Dosage may need to be reduced.
Administration
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
IV Preparation
IV push: Dilute 2.5-15 mg in 4-5 mL of SWI
Infusion: Dilute in D5W to 0.1-1 mg/mL
Solution should be colorless; if it is discolored, do not administer
IV Administration
IV push: Administer over 4-5 minutes
Continuous infusion: Administer via controlled infusion device
Contra Indications
Respiratory depression, acute or severe asthma; paralytic ileus; obstructive airway disease; acute liver disease; comatose patients; increased intracranial pressure; acute alcoholism. Pulmonary oedema resulting from a chemical respiratory irritant.
Precautions
Patient w/ impaired resp function, severe bronchial asthma, convulsive disorders, acute alcoholism, delirium tremens, raised intracranial pressure, hypotension w/ hypovolaemia, cardiac arrhythmias, severe cor pulmonale, history of substance abuse, diseases of the biliary tract, pancreatitis, inflammatory bowel disorders, prostatic hypertrophy, adrenocortical insufficiency, toxic psychoses. Opioid dependent patients. Renal and hepatic impairment. Pregnancy and lactation. Patient Counselling May impair ability to drive or operate machinery. Monitoring Parameters Monitor efficacy of pain control, vital signs, and mental status; signs of drug abuse, addiction, or diversion; signs or symptoms of hypogonadism or hypoadrenalism.
Pregnancy-Lactation
Pregnancy category: C; D if prolonged use/high doses at term.
Interactions
Additive depressant effects w/ other CNS depressants (e.g. sedatives, hypnotics, general anaesth, phenothiazines, other tranquilisers). May enhance the neuromuscular blocking action of skeletal muscle relaxants. Reduced analgesic effect w/ mixed agonist/antagonist opioid analgesics (e.g. pentazocine, nalbuphine, buprenorphine). Increased plasma concentrations w/ cimetidine. May reduce the efficacy of diuretics by inducing the release of antidiuretic hormone. May delay the absorption of mexiletine. May antagonise the GI effect of cisapride, domperidone and metoclopramide. May produce hyperpyrexia and CNS toxicity w/ dopaminergics.
Potentially Fatal: MAOIs intensify the effect of morphine resulting to severe and even fatal events (e.g. anxiety, confusion, resp depression, sometimes leading to coma).
Adverse Effects
Side effects of Morphine Sulphate :
>10%
Pruritus (≤80%),Urinary retention (epidural/IT) (15-70%),Vomiting (7-70%),Constipation (>10%),Headache (>10%),Somnolence (>10%)
1-10%
Abdominal pain (5-10%),Asthenia (5-10%),Backache (5-10%),Depression (5-10%),Diarrhea (5-10%),Dyspnea (5-10%),Fever (5-10%),Insomnia (5 -10% ),Loss of appetite (5-10%),Nausea (5-10%),Paresthesia (5-10%),Peripheral edema (5-10%),Rash (5-10%),Sweating (5-10%),Xerostomia (5-10%),Respiratory depression (IT) (4-7%),Anxiety (6%),Dizziness (6%),Abnormal liver function test results (<5%),Amblyopia (<5%),Hiccups (<5%),Orthostatic hypotension (<5%),Syncope (<5%),Urinary retention (PO) (<5%)
<1%
Respiratory depression (epidural) (0.25-0.4% )
Frequency Not Defined
Anaphylaxis (rare ),Cardiac arrest,Circulatory depression,Finding of intracranial pressure,Ileus,Lightheadedness,Malaise,Miosis,Myoclonus,Shock,Thinking disturbances,Vertigo
Potentially Fatal: Respiratory depression; circulatory failure; hypotension; deepening coma; anaphylactic reactions.
Mechanism of Action
Morphine is a phenanthrene derivative which acts mainly on the CNS and smooth muscles. It binds to opiate receptors in the CNS altering pain perception and response. Analgesia, euphoria and dependence are thought to be due to its action at the mu-1 receptors while resp depression and inhibition of intestinal movements are due to action at the mu-2 receptors. Spinal analgesia is mediated by morphine agonist action at the K receptor.
Note
Mor 10 10mg Syrup manufactured by National Healthcare Pvt. Ltd.. Its generic name is Morphine Sulphate. Mor 10 is availble in Nepal.
Farmaco Nepal drug index information on Mor 10 Syrup is not intended for diagnosis, medical advice or treatment; neither intended to be a substitute for the exercise of professional judgment.