Index of drugs

For intravenous, epidural or subarachnoid use to treat high-intensity pains that do not disappear after non-opioid analgesics.

1 amp. 2 ml contains 2 mg of morphine sulphate.

A strong opioid analgesic. It acts on opioid receptors distributed in o.u.n., has specific affinity for mi receptors. Epidural or subarachnoid administration provides long-lasting analgesic action without disturbing motor function, sensation and sympathetic activity. The drug causes drowsiness, mood changes, decreased body temperature, dose-dependent respiratory suppression. The analgesic effect is also caused by the modification of the release of neurotransmitters from afferent nerve fibers. In inflamed tissues migration occurs and increased concentration of opioid receptors, which affects the peripheral analgesic effect of morphine. It dilates blood vessels, initially increases and then reduces the tone of the gastrointestinal tract and the urinary and biliary tracts while maintaining sphincter spasms. The result is pyloric spasm, delayed gastric emptying, increased pressure in the bile and urinary tract, slow peristaltis, constipation, urination disorders. It inhibits the secretory activity of the adrenal cortex in response to stress stimulus; does not affect tendon and autonomic reflexes. It may cause an increase in the level of histamine in the blood (in patients with asthma, it may trigger bronchospasm). After intravenous administration, the maximum serum concentration occurs after 30 s, and after 15-30 min in the cerebrospinal fluid. The maximum analgesic effect occurs after 30-45 min. After the epidural and subarachnoid administration, the maximum concentration of the drug in the serum occurs after 30 min and decreases to very low values ​​within 2-4 h. The analgesic effect occurs after 15-60 min and persists for 24 hours._0,5 after the parenteral administration is 1.5-2 h. In about 30% morphine is bound to plasma proteins, the unbound part is rapidly redistributed to the tissues. The drug is metabolized in the liver to morphine-6-glucuronide (active form) and morphine-3-glucuronide (inactive form). 90% of the drug is excreted in the urine, 10% in the faeces.

Hypersensitivity to morphine or other opioid analgesics. acute bronchial asthma or obstructive airway obstruction. General contraindications for subarachnoid and epidural use: inflammation at the injection site, simultaneous treatment with anticoagulants, haemorrhagic diathesis; other clinical conditions that are contraindicated for the administration of epidural or intrathecal morphine.

With subarachnoid and epidural administration there is a risk of respiratory depression, with subarachnoid administration it is higher. It is recommended to limit the use of the product to the lumbar spine. After administration of epidural or subarachnoid morphine, patients who have undergone surgery in the bile duct or in patients with biliary function disorders may experience biliary colic. When administered intravenously, special care should be taken in elderly, debilitated patients, after head injuries, in the case of increased intracranial or intraocular pressure. The narrowing of the pupils caused by morphine may hinder the diagnosis of patients with intracranial pathology. Special care should be taken in patients with reduced respiratory reserve (eg emphysema, kyphoscoliosis, severe obesity), in patients with metabolic disorders, impaired liver or kidney function, hypothyroidism. Use caution in patients with history of epilepsy or seizures. Increased smooth muscle tone after administration of morphine may cause hepatic or renal colic and difficulties in urination. In patients with prostatic hyperplasia, morphine may cause urinary retention requiring permanent catheterization.In patients with reduced circulating blood volume, cardiac dysfunction, and those treated with adrenolytics, there is a risk of orthostatic hypotension. In patients with chronic obstructive pulmonary disease and in patients with acute bronchial asthma, administration of morphine may cause acute respiratory failure.

It can be used during pregnancy with extreme caution only if clearly necessary. In newborns of mothers using morphine for a long time during pregnancy, symptoms of withdrawal syndrome may occur. Use during labor is not recommended. The drug is excreted in breast milk - no effects on the fed baby were established.

The most serious side effect is the inhibition of the respiratory center; after a single epidural or subarachnoid administration, early or late (up to 24 h) inhibition of the respiratory center may occur. Small doses of the drug have no significant effect on the cardiovascular system, large doses can have a stimulating effect. Large doses may cause agitation, fits, mood disorders, psychosis. After epidural or subarachnoid administration, pruritis may occur not only at the injection site. Often, after urinary or epidural administration, urine retention may occur (which may persist for 10-20 hours), and is more common in men. Pruritus, nausea, vomiting, urinary retention may be suppressed by intravenous administration of a small dose of naloxone (0.2 mg). In addition, there may be constipation, headache, dizziness, euphoria, anxiety, cough reflex, disturbances in thermoregulation center, oliguria, urticaria, urticar and / or local tissue irritation. In some patients, tolerance to morphine may develop during treatment. Morphine, used for a long time, can lead to mental and physical dependence, and after sudden withdrawal to withdrawal syndrome.

The product does not contain preservatives and can be used intravenously, epidural and subarachnoid. Due to the greater risk of early and late adverse reactions following intrathecal administration of morphine, epidural administration should be used if possible. Epidural and spinal injections are recommended to be performed in the lumbar region of the spine. The preparation can be used either epidural or spinal fluid only by an experienced physician familiar with the technique and side effects associated with this route of administration. In the treatment of chronic pain, after starting the therapy in a hospital setting, supervised treatment can be continued outpatient or at home.
Dosage should be determined individually.intravenous: the starting dose in adults is usually 2-10 mg / 70 kg body weight There are no data on the use of the preparation in patients under 18 years of age.epidural (in the lumbar region): the starting dose in adults is 5 mg (should provide analgesia for 24 hours); if analgesia does not occur within 1 hour, a supplemental dose of 1-2 mg may be given with caution; do not exceed the 10 mg / day dose; in continuous infusion the usual starting dose is 2-4 mg / day; if the dose is ineffective, a supplementary dose can be given - 1-2 mg. Epidural administration in the thoracic spine even 1-2 mg may cause symptoms of respiratory depression. In elderly patients, doses lower than 5 mg can provide sufficient analgesia for 24 hours.subarachnoidally (only in the lumbar region): in adults 0.2-1 mg in a single dose (should provide analgesia for 24 hours). Do not use subarachnoid more than 1 ml of solution. Repeated subarachnoid injections are not recommended. Continuous intravenous infusion of naloxone hydrochloride at a dose of 0.6 mg / h for 24 h after subarachnoid administration reduces the risk of side effects. If analgesia is insufficient, other routes of administration should be considered. Use smaller doses in ragged and elderly people. The safety of morphine epidural and subarachnoid in children has not been established.