[[morphine]]

​​Morphine is an opioid used for background and breakthrough pain relief.

​ ​Pain ​ ​Dyspnoea ​ ​

​​

This section is a stub and needs content added.

2019/07/08 14:03 · Graham Grove

​ ​Pharmacodynamics ​​

This section is a stub and needs content added.

2019/07/08 14:03 · Graham Grove

​​ Morphine can be given orally and subcutaneously. Given its oral bioavailability, a subcutaneous dose of morphine should be around one-third to one-half of the oral dose. ​​ ​​Dosing in an opioid naïve patient is age related and typical starting doses may be:

Age Form and route Typical starting dose
Young and middle aged adult ​​Oral immediate release 10mg for breakthrough pain
Oral modified release 10mg twice daily
Subcut stat 5mg for breakthrough pain
CSCI 15mg over 24 hours
Elderly adult ​ ​Oral immediate release ​​5mg for breakthrough pain
Oral modified release
​Subcut stat 2.5mg for breakthrough pain
::: O ​​CSCI 10mg over 24 hours

Equianalgesic doses

​​1mg of subcut morphine ​​= 3mg or oral morphine ​​= 1mg of SC oxycodone ​​= 2mg of oral oxycodone ​​ = 0.2mg of subcut hydromorphone ​​= 0.6mg of oral hydromorphone ​​= 15 microgs of subcut fentanyl

Equivalence tables only give approximate doses and it is always wise to use caution and be conservative in dosing when undertaking a conversion. ​

Morphine (milligrams) Oxycodone (milligrams) Fentanyl (micrograms)
Oral Subcut Oral Subcut Patch Subcut
5 2.5 5 2.5 25
10 2.5-5 10 2.5-5 50
15 5 10 5 75
20 5-7.5 15 5-7.5 100
30 10 20 10 150
45 15 30 15 225
60 20 40 20 300
90 30 60 30 450
120 40 80 40 600
180 60 120 60 900
240 80 160 80 1200
300 100 200 100 1500
A 20mg buprenorphine patch approximately equals a 12microgram/hour fentanyl patch
2019/07/08 13:13 · Graham Grove

​​Compatibilities in a CSCI

​​ ​​Morphine can be mixed safely with a large combinations of other medications in a continuous subcutaneous infusion.

Second Drug Diluent
Morphine + Cyclizine Water
Haloperidol Water or Saline
Hyoscine butylbromide Water
Ketamine Saline
Levomepromazine Water or Saline
Metoclopramide Water or Saline
Midazolam Water or Saline
Octreotide Saline
Ondansetron Water or Saline
2019/07/03 23:06 · Graham Grove
Second Drug Third Drug Diluent
Morphine + Cyclizine + Midazolam Water
Halperidol + Cyclizine Water
Hyoscine butylbromide Water or Saline
Ketamine Saline
Midazolam Water or Saline
Octreotide Water or Saline
Hyoscine butylbromide + Octreotide Saline
Ondansetron Saline
Ranitidine Water
Levomepromazine + Hyoscine butlybromide Water or Saline
Metoclopramide Water or Saline
Midazolam Water or Saline
Octreotide Water or Saline
Ranitidine * Water
Metoclopramide + Ondansetron Saline
Ranitidine Saline
Midazolam + Cyclizine Water
Hyoscine butylbromide Water or Saline
Ketamine Water or Saline
Octreotide Water or Saline
Ondansetron Saline
* Add ranitidine last once all other drugs and diluent have been combined. Precipitation reported with high doses of levomepromazine > 75mg
2019/07/03 23:10 · Graham Grove
Second Drug Third Drug Fourth Drug Diluent
Morphine + Haloperidol + Cyclizine + Octreotide Water
Ranitidine Water
Hyoscine butlybromide + Ranitidine Water
Midazolam + Cyclizine Water
Hyoscine butylbromide Water
Levomepromazine + Hyoscine butylbromide + Octreotide Saline
Ranitidine * Water
Midazolam + Hyoscine butylbromide Water
Ketamine Saline
Metoclopramide Water or Saline
Ondansetron Water
Metoclopramide + Midazolam + Ketamine Saline
Octreotide Water or Saline
Ondansetron + Octreotide Saline
Midazolam + Hyoscine butylbromide + Octreotide Saline
Cyclizine + Ondansetron Water
* ​​Add ranitidine last once all other drugs and diluent have been combined. Precipitation reported with high doses of levomepromazine > 75mg
2019/07/03 23:15 · Graham Grove
  • morphine.txt
  • Last modified: 2020/02/12 22:57
  • by Graham Grove