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Morphine

Moderate-severe pain, Acute pulmonary edema, ACS pain management

Indications

  • Moderate-severe pain
  • Acute pulmonary edema
  • ACS pain management

Adult dosing

  • analgesia: dose: 0.1; unit: mg/kg; route: IV; interval: q4-6h; weightBased: true; maxDose: 15; maxDoseAbsolute: true; titration: dose: 2; maxDose: 4; unit: mg; route: IV; interval: q5-15min; fixed: true

Pediatric dosing

  • analgesia iv: dose: 0.1; unit: mg/kg; maxDose: 10; maxDoseAbsolute: true; route: IV; interval: q4-6h; weightBased: true; analgesia im: dose: 0.1; unit: mg/kg; maxDose: 10; maxDoseAbsolute: true; route: IM; interval: q4-6h; weightBased: true

Contraindications

  • Severe renal impairment (use fentanyl instead)
  • Acute/severe asthma
  • Paralytic ileus

Clinical pearls

  • Avoid in renal failure — active metabolite morphine-6-glucuronide accumulates
  • Causes histamine release — can cause hypotension and bronchospasm
  • Use fentanyl instead in hemodynamically unstable patients

Source and review

  • Tintinalli's Emergency Medicine, 9th ed.. Last reviewed: 2024-10-01