Morphine

Morphine Brand Names

ARYMO ER | Astramorph PF | Avinza | DepoDur | Duramorph PF | Infumorph | Kadian | MORPHABOND | MS Contin | MSIR | Oramorph SR | RMS | Roxanol | Roxanol-T

What is Morphine

Morphine is the principal alkaloid obtained from the unripened seed capsules of the opium poppy, Papaver somniferum. It was first isolated in 1803 and is the prototype of the opiate agonists.

Today, the poppy is still the source of the drug because synthesis of morphine is difficult. Morphine is a strong analgesic that has been used for the relief of moderate to severe acute and chronic pain, for preoperative sedation, and as a supplement to anesthesia; the drug has also been used for analgesia during labor.

Morphine is the drug of choice for pain associated with myocardial infarction and cancer.

Many different formulations of morphine are available including both extended-release and immediate-release injectable and oral dosage forms, rectal suppositories, and bulk powder for compounding.

Morphine was initially marketed before 1962, which is when Congress passed the amended Federal Food, Drug, and Cosmetic Act requiring that the FDA establish both safety and efficacy for all subsequently approved drugs. Many products were approved under current regulations; however, some manufacturers of morphine have not submitted their products for formal evaluation by the FDA.

On March 31st 2009, the FDA issued a Warning Letter to specific manufacturers to halt the production and distribution of the unapproved products. Based on this action, all single ingredient morphine products marketed after July 1, 2009 must be FDA approved.

Two formulations of opium tincture, deodorized opium tincture and camphorated opium tincture, contain anhydrous morphine and may be useful for the treatment of non-infectious diarrhea. Opium tinctures have not been found to be safe and effective by the FDA, and they are considered unapproved drugs.

Serious medication errors have resulted from confusion between the products, as the deodorized tincture is 25-times more concentrated than the camphorated tincture.

Indications

1. diabetic neuropathy
2. diarrhea
3. dysautonomia
4. dyspnea
5. moderate pain
6. neonatal abstinence syndrome
7. procedural sedation
8. rapid-sequence intubation
9. severe pain
10. tetanus

Side Effects

1. abdominal pain
2. adrenocortical insufficiency
3. agitation
4. amblyopia
5. amenorrhea
6. amnesia
7. anaphylactoid reactions
8. anemia
9. anorexia
10. anxiety
11. apnea
12. arthralgia
13. asthenia
14. ataxia
15. atrial fibrillation
16. back pain
17. biliary obstruction
18. bladder spasm
19. blurred vision
20. bone pain
21. bradycardia
22. bronchospasm
23. cardiac arrest
24. chest pain (unspecified)
25. chills
26. coma
27. confusion
28. conjunctivitis
29. constipation
30. delirium
31. depression
32. diaphoresis
33. diarrhea
34. diplopia
35. dizziness
36. drowsiness
37. dysgeusia
38. dyspepsia
39. dysphagia
40. dysphoria
41. dyspnea
42. dysuria
43. edema
44. euphoria
45. fever
46. flatulence
47. flushing
48. gastroesophageal reflux
49. GI obstruction
50. gonadal suppression
51. gynecomastia
52. hallucinations
53. headache
54. hiccups
55. hyperalgesia
56. hyperamylasemia
57. hypertension
58. hypoesthesia
59. hypokalemia
60. hyponatremia
61. hypotension
62. hypoventilation
63. hypoxia
64. ileus
65. impotence (erectile dysfunction)
66. increased intracranial pressure
67. infection
68. infertility
69. insomnia
70. laryngospasm
71. lethargy
72. leukopenia
73. libido decrease
74. malaise
75. miosis
76. myoclonia
77. nausea
78. neonatal opioid withdrawal syndrome
79. nystagmus
80. ocular pain
81. oliguria
82. orthostatic hypotension
83. pallor
84. palpitations
85. paresis
86. paresthesias
87. peripheral edema
88. peripheral vasodilation
89. physiological dependence
90. pruritus
91. psychological dependence
92. psychosis
93. pulmonary edema
94. rash
95. respiratory arrest
96. respiratory depression
97. restlessness
98. rhinitis
99. seizures
100. serotonin syndrome
101. SIADH
102. sinus tachycardia
103. syncope
104. thrombocytopenia
105. tolerance
106. tremor
107. urinary retention
108. urticaria
109. vertigo
110. vomiting
111. weakness
112. weight loss
113. withdrawal
114. xerosis
115. xerostomia

Monitoring Parameters

• serum sodium

Contraindications

• abrupt discontinuation
• accidental exposure
• acute abdomen
• adrenal insufficiency
• alcoholism
• angina
• anticoagulant therapy
• arteriosclerosis
• asthma
• atrial fibrillation
• atrial flutter
• biliary tract disease
• bladder obstruction
• brain tumor
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• CNS depression
• coadministration with other CNS depressants
• coagulopathy
• coma
• constipation
• cor pulmonale
• depression
• diarrhea
• driving or operating machinery
• emphysema
• ethanol ingestion
• ethanol intoxication
• geriatric
• GI bleeding
• GI disease
• GI obstruction
• head trauma
• heart failure
• hepatic disease
• hypotension
• hypothyroidism
• hypovolemia
• hypoxemia
• ileus
• increased intracranial pressure
• infants
• infection
• infertility
• inflammatory bowel disease
• intramuscular administration
• intrathecal administration
• intravenous administration
• labor
• MAOI therapy
• myxedema
• neonatal opioid withdrawal syndrome
• neonates
• obesity
• obstetric delivery
• oliguria
• opiate agonist hypersensitivity
• opioid overdose
• opioid use disorder
• opioid-naive patients
• orthostatic hypotension
• potential for overdose or poisoning
• pregnancy
• prostatic hypertrophy
• pulmonary disease
• renal disease
• renal impairment
• reproductive risk
• requires a specialized care setting
• requires an experienced clinician
• respiratory depression
• respiratory insufficiency
• scoliosis
• seizure disorder
• seizures
• shock
• sleep apnea
• status asthmaticus
• status epilepticus
• strychnine toxicity
• subcutaneous administration
• substance abuse
• ulcerative colitis
• urethral stricture
• urinary retention

Interactions

• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Tramadol
• Acrivastine; Pseudoephedrine
• Adefovir
• Aldesleukin, IL-2
• Alfentanil
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Almotriptan
• Alosetron
• Alprazolam
• Alvimopan
• Amide local anesthetics
• Amifampridine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amobarbital
• Amoxapine
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamines
• Anticholinergics
• Apomorphine
• Apraclonidine
• Aripiprazole
• Articaine; Epinephrine
• Asenapine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Atropine
• Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Atropine; Difenoxin
• Atropine; Diphenoxylate
• Atropine; Edrophonium
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine
• Azelastine; Fluticasone
• Azilsartan; Chlorthalidone
• Baclofen
• Barbiturates
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
• Benzphetamine
• Benztropine
• Bethanechol
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Boceprevir
• Brexpiprazole
• Brigatinib
• Brimonidine
• Brimonidine; Brinzolamide
• Brimonidine; Timolol
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Bumetanide
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Butorphanol
• Cabozantinib
• Candesartan; Hydrochlorothiazide, HCTZ
• Cannabidiol
• Capmatinib
• Capsaicin; Metaxalone
• Captopril; Hydrochlorothiazide, HCTZ
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbetapentane; Pyrilamine
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carisoprodol
• Carvedilol
• Cenobamate
• Cetirizine
• Cetirizine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chloral Hydrate
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chlorothiazide
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Chlorzoxazone
• Cimetidine
• Citalopram
• Clemastine
• Clobazam
• Clomipramine
• Clonazepam
• Clonidine
• Clopidogrel
• Clorazepate
• Clozapine
• Cobicistat
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• COMT inhibitors
• Conivaptan
• Crofelemer
• Cyclizine
• Cyclobenzaprine
• Cyproheptadine
• Daclatasvir
• Dantrolene
• Darifenacin
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Desflurane
• Desipramine
• Desmopressin
• Desvenlafaxine
• Deutetrabenazine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmedetomidine
• Dexpanthenol
• Dextroamphetamine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Dicyclomine
• Dienogest; Estradiol valerate
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Dolasetron
• Donepezil; Memantine
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Dronabinol
• Droperidol
• Drospirenone
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Duloxetine
• Elagolix; Estradiol; Norethindrone acetate
• Eletriptan
• Elexacaftor; tezacaftor; ivacaftor
• Eliglustat
• Eltrombopag
• Eluxadoline
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Enflurane
• Entecavir
• Eprosartan; Hydrochlorothiazide, HCTZ
• Escitalopram
• Esketamine
• Esmolol
• Estazolam
• Estradiol; Levonorgestrel
• Estradiol; Norethindrone
• Estradiol; Norgestimate
• Eszopiclone
• Ethacrynic Acid
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethotoin
• Etomidate
• Etravirine
• Fenfluramine
• Fentanyl
• Fesoterodine
• Flavoxate
• Flibanserin
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluvoxamine
• Fosamprenavir
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Fospropofol
• Fostamatinib
• Frovatriptan
• Furosemide
• Gabapentin
• General anesthetics
• Glecaprevir; Pibrentasvir
• Glycopyrrolate
• Glycopyrrolate; Formoterol
• Granisetron
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guanabenz
• Guanfacine
• Haloperidol
• Halothane
• Homatropine; Hydrocodone
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydromorphone
• Hydroxyzine
• Hyoscyamine
• Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
• Ibuprofen; Oxycodone
• Iloperidone
• Imipramine
• Indacaterol; Glycopyrrolate
• Indapamide
• Isocarboxazid
• Isoflurane
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Istradefylline
• Ivacaftor
• Ixabepilone
• Ketamine
• Lapatinib
• Lasmiditan
• Ledipasvir; Sofosbuvir
• Lemborexant
• Leuprolide; Norethindrone
• Levobupivacaine
• Levocetirizine
• Levomilnacipran
• Levonorgestrel
• Lidocaine
• Lidocaine; Prilocaine
• Lincosamides
• Linezolid
• Lisdexamfetamine
• Lithium
• Lofexidine
• Loop diuretics
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorazepam
• Lorcaserin
• Loxapine
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Lumateperone
• Lurasidone
• Magnesium Salts
• Maprotiline
• Melatonin
• Memantine
• Mepenzolate
• Meperidine; Promethazine
• Mephobarbital
• Mepivacaine
• Mepivacaine; Levonordefrin
• Meprobamate
• Mestranol; Norethindrone
• Metaxalone
• Methadone
• Methamphetamine
• Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
• Methocarbamol
• Methohexital
• Methscopolamine
• Methyclothiazide
• Methyldopa
• Methylene Blue
• Methylphenidate
• Metoclopramide
• Metolazone
• Metyrapone
• Metyrosine
• Midazolam
• Milnacipran
• Minocycline
• Mirtazapine
• Molindone
• Monoamine oxidase inhibitors
• Nabilone
• Nalbuphine
• Naloxone
• Naltrexone
• Naproxen; Sumatriptan
• Naratriptan
• Nefazodone
• Neratinib
• Nesiritide, BNP
• Nitroglycerin
• Norethindrone
• Norgestrel
• Nortriptyline
• Octreotide
• Olanzapine
• Ombitasvir; Paritaprevir; Ritonavir
• Ondansetron
• Oral Contraceptives
• Orphenadrine
• Osimertinib
• Oxazepam
• Oxybutynin
• Oxycodone
• Oxymorphone
• Ozanimod
• Paliperidone
• Palonosetron
• Papaverine
• Paroxetine
• Pegvisomant
• Pentazocine
• Pentazocine; Naloxone
• Pentobarbital
• Perampanel
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Posaconazole
• Potassium-sparing diuretics
• Pramipexole
• Pramlintide
• Prasugrel
• Pregabalin
• Prilocaine
• Prilocaine; Epinephrine
• Primidone
• Procarbazine
• Prochlorperazine
• Promethazine
• Propantheline
• Propofol
• Protriptyline
• Quazepam
• Quetiapine
• Quinidine
• Ramelteon
• Rasagiline
• Rifampin
• Risperidone
• Ritonavir
• Rizatriptan
• Rolapitant
• Ropinirole
• Ropivacaine
• Rotigotine
• Safinamide
• Sapropterin
• Scopolamine
• Secobarbital
• Segesterone Acetate; Ethinyl Estradiol
• Selegiline
• Serotonin norepinephrine reuptake inhibitors
• Serotonin-Receptor Agonists
• Serotonin-Receptor Antagonists
• Sertraline
• Sevoflurane
• Sibutramine
• Sildenafil
• Simeprevir
• Sincalide
• Sodium Oxybate
• Sofosbuvir; Velpatasvir; Voxilaprevir
• Solifenacin
• Sorafenib
• Spironolactone
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sumatriptan
• Suvorexant
• Tapentadol
• Tasimelteon
• Tedizolid
• Telaprevir
• Temazepam
• Temsirolimus
• Tetrabenazine
• Tezacaftor; Ivacaftor
• Thalidomide
• Thiazide diuretics
• Thiopental
• Thioridazine
• Thiothixene
• Ticagrelor
• Tizanidine
• Tolterodine
• Torsemide
• Tramadol
• Tranylcypromine
• Trazodone
• Triamterene
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trihexyphenidyl
• Trimethobenzamide
• Trimipramine
• Triprolidine
• Trospium
• Tucatinib
• Valerian, Valeriana officinalis
• Valproic Acid, Divalproex Sodium
• Vemurafenib
• Venlafaxine
• Vigabatrin
• Vilazodone
• Vortioxetine
• Zaleplon
• Ziconotide
• Ziprasidone
• Zolmitriptan
• Zolpidem
• Zonisamide