morphine
Indication
- Narcotic analgesic used for pain relief and sedation
- Management of neonatal opioid withdrawal syndrome (NOWS)
Dosage Guidelines
- Anglgesia/Sedation: Titrate to response or side effects
50-200 microgram/kg/dose IV/IM/SUBCUT/rectal
200-500 microgram/kg/dose ORAL q4 hours prn
5-20 microgram/kg/hr IV continuous infusion
- Neonatal Opioid Withdrawal Syndrome (follow NOWS algorithm and maximize non-pharmacologic interventions first)
May consider a one-time dose of 50 microgram/kg to settle infant on admission. If additional doses are needed, order 50 microgram/kg/dose q4 hours PRN. If 3 doses are needed in a 24-hour period, switch to standing doses (50-100 microcgram/kg/dose q4 hours).
Weaning is based on clinical symptoms and success in the ESC framework. Wean by 10-15% q48 hours as tolerated.
Administration
- ORAL
- IV direct over 3-5 minutes
- IV continuous infusion
- For patients 2 kg or less: Use morphine [0.04 mg/mL]
To make 25 mL of morphine [0.04 mg/mL] [1 mg/25 mL] solution:
- Add 0.5 mL (1 mg) of morphine [2 mg/mL] to 24.5 mL of solution
- For patients over 2 kg to 4 kg: Use morphine [0.08 mg/mL]
To make 25 mL of morphine [0.08 mg/mL] [2 mg/ 25 mL] solution:
- Add 1 mL (2 mg) of morphine [2 mg/mL] to 24 mL of solution
- For patients over 4 kg to 10 kg: Use morphine [0.2 mg/mL]
- To make 25 mL of morphine [0.2 mg/mL] [5 mg/25 mL] solution:
- Add 2.5 mL (5 mg) of morphine [2 mg/mL] to 22.5 mL of solution
Adverse Effects
- Decreased gastric emptying, constipation, nausea, vomiting, urinary retention, narcotic dependence
- Dose dependent effects: respiratory and CNS depression, bradycardia, hypotension, miosis
Comments
- IV onset: within 10 minutes. Half-life is 10 to 20 hours in preterm infants
- When converting from IV to oral dosing, the total daily dose of IV morphine should be multiplied by 2-3 due to the decreased bioavailability of oral morphine
- Monitor cardiovascular and respiratory status, abdominal distention or loss of bowel sounds, level of sedation, NPASS score as per protocol
- Taper dose after prolonged use to prevent withdrawal
Supplied As
- 1 mg/mL oral syrup (0.25 mL and 0.5 mL)
- 2 mg/mL ampoule for injection
- Nurse to prepare syringes based on patient weight
For patients 2 kg or less: morphine [0.04 mg/mL]
For patients over 2 kg to 4 kg: morphine [0.08 mg/mL]
For patients over 4 kg to 10 kg: morphine [0.2 mg/mL]
- At LHSC, standard concentration reference charts are available on the NICU Intranet site
References
LexiComp Sick Kids, LexiComp Pediatric and Neonatal