Dosage and Administration
for Using Morphine Sulphate®

Adults and children over 12 years:
Morphine Sulphate Injection is formulated for use by intravenous injection in Patient Controlled Analgesia (PCA) systems. PCA, which permits adjustment of dosage according to the patient's individual needs, must only be carried out in departments and by staff who are trained and have experience of the system. Patient selection for the use of PCA must ensure that the patient is capable of understanding and following the instructions of the medical/nursing staff. The specific department or unit protocols must be covered to ensure aseptic transfer of the contents of the vial to the PCA system.

There is a considerable variation in analgesic requirements among patients and therefore individualised treatment strategies are required. Dosage should be based on the severity of the pain and the response and opiate tolerance of the patient.

Loading dose:
Loading doses of typically between 1mg and 10mg (maximum 15mg) of morphine sulphate may be given by intravenous infusion over four or five minutes. The loading dose used will depend upon the patient's diagnosis and condition.

PCA demand dose:
An initial demand dose of 1mg Morphine Sulphate Injection with a lockout period of 5 to 10 minutes is recommended. Dosages may vary depending on the loading dose, the tolerance and condition of the patient, and whether a background infusion of morphine sulphate is being given.
The patient should be specifically monitored for pain, sedation and respiratory rate during the first few hours of treatment to ensure that the dosage regimen is suitable.
The duration of treatment should be kept to a minimum, although dependence and tolerance are not generally a problem when morphine is used legitimately in patients with opioid-sensitive pain.

Use in children:
Not recommended for children under 12 years.

Use in the elderly:
Morphine doses need to be reduced in elderly patients.

Contraindications
Morphine Sulphate Injection should not be given to patients with known hypersensitivity to morphine or other opioid preparations. Use of Morphine Sulphate Injection is also contra-indicated in patients with respiratory depression; obstructive airways disease; excessive bronchial secretions; during a bronchial asthma attack or in heart failure secondary to chronic lung disease; head injury; raised intra-cranial pressure; coma; convulsion disorders; ulcerative colitis; in presence of a risk of paralytic ileus; biliary and renal tract spasm and acute alcoholism; phaeochromocytoma.

Morphine Sulphate Injection should not be given to patients with moderate to severe renal impairment (glomerular filtration rate <20ml/min) or with severe or acute liver failure.

Morphine Sulphate Injection is contra-indicated in patients receiving monoamine oxidase inhibitors or within two weeks of discontinuing such treatment. Use of Morphine Sulphate Injection during pregnancy or lactation is not recommended.