Morphine

Morphine – narcotic drug with analgeziruyushchy action.

Form of release and structure

Morphine produce in the form of solution for hypodermic introduction 10 mg/ml: transparent, colourless or yellowish (in the syringe tubes on 1 ml, on 20, 50 or 100 syringes in a cardboard pack).

Is a part of 1 ml of solution:

• Active agent: a morphine hydrochloride – 8,56 mg (in terms of anhydrous substance);
• Auxiliary components: эдетат dinatrium (disodium salt of ethylene diamine tetraacetic acid), solution of Acidum hydrochloricum of 0,1 M, глицерол (the glycerin distilled), water for injections.

Indications to use

Morphine is appointed as anesthetic at the expressed pain syndrome which arose for various reasons:

• Injuries;
• Heavy attacks of stenocardia;
• Myocardial infarction;
• Preoperative, operational and postoperative period;
• Pains at malignancies;
• Other states which are followed by severe pains.

Contraindications

Absolute:

• The states which are followed by the expressed oppression of the central nervous system or respiratory depression;
• Paralytic intestinal impassability;
• Convulsive states;
• The increased intracranial pressure;
• Head injuries;
• Alcoholic psychosis and acute alcoholic states;
• Bronchial asthma;
• Cardiac arrhythmias;
• The heart failure caused by chronic diseases of lungs;
• States after carrying out surgical interventions on biliary tract;
• Acute surgical diseases of abdominal organs (before diagnosis);
• Simultaneous use with monoamine oxidase inhibitors, and also for 14 days after their cancellation;
• Hypersensitivity to drug components.

Relative (Morphine should be applied with care in the presence of the following diseases / states):

• Chronic obstructive pulmonary disease;
• Medicinal dependence (including in the anamnesis);
• Suicide bent;
• Alcoholism;
• Cholelithiasis;
• Emotional lability;
• Urethra strictures;
• Epileptic syndrome;
• Surgical interventions on digestive tract, an urinary system;
• Renal or liver failure;
• Hypothyroidism;
• Prostate hyperplasia;
• Serious inflammatory illnesses of intestines;
• General serious condition of the patient;
• Advanced and children's age.

To the feeding and pregnant women, and also in the period of the sorts Morphine it is possible to apply only according to vital indications (because of probability of development of medicinal dependence in a fruit and the newborn).

Route of administration and dosage

Morphine should be entered subcutaneously.

The anesthetizing action develops 10-15 minutes later after introduction, in 1-2 hours it reaches a maximum and remains for 8-12 and more hours.

The doctor selects a drug dose individually on the basis of a condition of the patient and his age:

• Adults: a standard dose – 1 ml of solution (10 mg/ml). The maximum doses make: one-time – 20 mg, daily – 50 mg;
• Children of 2 years: a single dose – 0,1-0,2 mg/kg; it is possible to enter drug each 4-6 hours, a total dose – no more than 1,5 mg/kg;
• Children up to 2 years: a single dose – 0,1-0,2 mg/kg; it is possible to enter drug each 4-6 hours, a total dose – no more than 15 mg.

Side effects

• Cardiovascular system: more often – tachycardia, lowering of arterial pressure; less often – bradycardia; with an unknown frequency – increase in arterial pressure;
• Alimentary system: more often – vomiting and nausea (as a rule, at the beginning of therapy), a lock; less often – spasms in a stomach, anorexia, dryness in a mouth, a spasm of biliary tract, a gastralgia, a cholestasia (in the main bilious channel); seldom – a hepatotoxic (it is shown in the form of dark urine, a pale chair, an ikterichnost of integuments and scleras), at serious inflammatory illnesses of intestines – paralytic intestinal impassability, an intestines atony, toxic megacolon (it is shown in the form of a lock, a meteorism, nausea, spasms in a stomach, vomitings);
• Nervous system: more often – a faint, dizziness, drowsiness, the general weakness, extraordinary fatigue; less often – a tremor, a headache, a depression, a diskoordination of muscular movements, involuntary muscular twitchings, nervousness, paresthesias, confusion of consciousness (it is shown in the form of hallucinations, depersonalization), sleeplessness, increase in intracranial pressure with probability of further disturbance of cerebral circulation; seldom – oppression of the central nervous system, an uneasy dream, at use of high doses – muscle tension (in particular respiratory), at children is concern, paradoxical excitement; with an unknown frequency – dreadful dreams, spasms, exciting or sedative action (in particular at elderly patients), a delirium, decline in the ability to concentration of attention;
• Respiratory system: more often – oppression of a respiratory center; less often – an atelectasis, a bronchospasm;
• Urinogenital system: less often – decrease in a diuresis, a spasm of ureters (it is shown in the form of difficulty and urodynias, frequent desires to an urination), decrease in a potentiality and libido; with an unknown frequency – a bladder sphincter spasm, disturbance of outflow of urine or aggravation of these states at a stenosis of an urethra and a hyperplasia of a prostate;
• Allergic reactions: more often – a hyperemia of the person, goose breathing, face skin rash; less often – urticaria, skin rash, a skin itch, hypostasis of a trachea and person, a fever, a laryngospasm;
• Local reactions: a hyperemia, burning and hypostasis in a solution injection site;
• Others: more often – a dysphonia, the increased sweating; less often – feeling of discomfort, disturbance of clearness of visual perception (including a diplopia), a nystagmus, a miosis, imaginary feeling of good health; with an unknown frequency – a ring in ears, tolerance, medicinal dependence, a withdrawal (it is shown in the form of muscular pains, diarrhea, tachycardia, a mydriasis, a hyperthermia, rhinitis, sneezing, perspiration, yawning, anorexia, nausea, vomiting, nervousness, fatigue, irritability, a tremor, spasms in a stomach, the general weakness, a hypoxia, muscular contractions, a headache, increase in arterial pressure and other vegetative symptoms).

At repeated use of Morphine for 1-2 weeks (in certain cases – 2-3 days) accustoming (it is shown in the form of weakening of the anesthetizing action) and opioid medicinal dependence can develop.

Special instructions

Morphine is applied with care at elderly patients, at diseases of kidneys and a liver, the general exhaustion, insufficiency of a bast layer of adrenal glands. In the reduced doses and under careful observation it is necessary to enter solution along with the drugs operating on the central nervous system including anesthetics, hypnotic drugs, anxiolytic, antihistaminic drugs, antidepressants, neuroleptics and other non-narcotic anesthetics (to avoid suppression of activity of a respiratory center and excessive oppression of the central nervous system).

Morphine should not be combined with narcotic analgetics from group of partial agonists (buprenorphine) and agonists antagonists of opioid receptors (nalbufiny, butorfanoly, tramadoly) because of danger of weakening of an analgesia and a possibility of development of a withdrawal in patients with dependence to opioids.

Analgetic action and undesirable effects of opioid agonists (fentanyl, trimeperidine) are summed up in the therapeutic range of doses with effects of Morphine.

During therapy it is impossible to allow the ethanol use.

In certain cases there can be a tolerance and dependence on drug.

At development of vomiting and nausea its appointment along with fenotiaziny is possible.

For decrease in side effect on intestines it is necessary to use purgatives.

It is impossible to apply Morphine in situations when emergence of paralytic Ilheus is possible (at threat of its development use of drug needs to be stopped immediately).

At patients with alleged heart operation or other surgical intervention with an intensive pain syndrome use of Morphine needs to be stopped in 24 hours prior to carrying out operation. At purpose of therapy further, the mode of dosing should be chosen taking into account weight of operation.

It is necessary to consider that children up to 2 years are more sensitive to effects of opioid analgetics, and at them development of paradoxical reactions is possible.

During therapy it is necessary to be careful at control of motor transport and performance of other potentially dangerous types of activity demanding the increased concentration of attention and bystry psychomotor reactions.

Medicinal interaction

At simultaneous use of Morphine with some medicines there can be following effects:

• Somnolent, sedative, mestnoanesteziruyushchy medicines, drugs for the general anesthesia and anxiolytics: strengthening of their action;
• The muscle relaxants, ethanol, drugs oppressing the central system: strengthening of the depriving of bonuses effect and respiratory depression;
• Buprenorphine (including the previous therapy): decrease in effect of Morphine;
• Mu agonists - opioid receptors (high doses): decrease in respiratory depression;
• Mu agonists - or a kappa - opioid receptors (low doses): strengthening of respiratory depression;
• Barbiturates, especially phenobarbital (systematic use): reduction of expressiveness of analgeziruyushchy effect of Morphine, stimulation of development of cross tolerance;
• Beta adrenoblockers: strengthening of the oppressing action on the central nervous system;
• Dopamine: reduction of analgeziruyushchy effect of Morphine;
• Cimetidinum: strengthening of respiratory depression;
• Other opioid analgetics: respiratory depression, central nervous system, lowering of arterial pressure;
• Chlorpromazinum: strengthening of miotic, sedative and analgeziruyushchy effects of Morphine;
• Derivatives of barbiturates and fenotiazin: strengthening of hypotensive effect and increase in risk of development of respiratory depression;
• Naloxonum: decrease in effects of Morphine, and also the caused drug of oppression of the central nervous system and breath; acceleration of development of symptoms of a withdrawal against the background of drug addiction;
• Naltrexone: acceleration of emergence of symptoms of a withdrawal against the background of drug addiction (symptoms can develop already 5 minutes later after administration of drug, proceed for 48 hours; are characterized by difficulty of elimination); decrease in analgetic, antidiarrheal and antibechic effect of Morphine; elimination of the respiratory depression drug caused by use;
• The medicines reducing arterial pressure (including ganglioblokator, diuretics): strengthening of hypotensive effect;
• Zidovudine: decrease in its clearance because of what the risk of their mutual intoxication increases;
• Drugs with anticholinergic activity, medicines with antidiarrheal action (including loperamide): increase in risk of development of a lock up to intestinal impassability, oppression of the central nervous system and an ischuria;
• Metoclopramidum: decrease in its effect.

Terms and storage conditions

To store in protected from light, the place, unavailable to children, at a temperature up to 15 °C.

Period of validity – 2 years.