morphine

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:

  1. 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:

  1. 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:
  1. 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