Classification: narcotic analgesic
  • acute and chronic severe pain
  • anginal pain and pain post myocardial infarction 
    • decreases preload
    • decreases afterload 
    • dilates coronary vessels
  • adjunctive treatment in acute pulmonary edema
  • Bolus dose:
    • analgesic:  2-5 mg IV direct; repeat prn
    • pulmonary edema:  10mg IV direct
  • Infusion:
    • administer IV bolus doses prn until pain control is achieved, then start infusion to maintain pain control
    • starting rate of 1-5 mg/hr; titrate to pain score and VAMAAS
  • IV Direct:
    • inject slowly as rapid injection may result in increased frequency of adverse effects
  • Infusion:
    • 100mg/50mL NS, D5W for syringe pump infusion
  • NOTE: Special preservative-free preparation is used for epidural administration (Epi-morphR)
  • hypovolemia should be treated prior to/or concurrent with drug administration
  • give analgesia before peak pain
Adverse Effects:
  • respiratory depression (maximum 7 minutes post IV dose)
  • hypotension
  • pinpoint pupils
  • decreased gastrointestinal motility; constipation
  • excessive sedation
  • inhibition of voluntary cough reflex; increased secretion retention - patients must be encouraged to cough
  • hallucinations
  • tolerance to the analgesic, respiratory depressant and sedative effects may develop with prolonged therapy
  • naloxone: 0.1-0.4mg IV (see naloxone monograph)
Drug Interactions:
  • morphine + CNS depressants = increased CNS depressant effect
  • morphine + antihypertensives = hypotensive effect
  • morphine + metoclopramide = antagonism of metoclopramide effect on gastrointestinal motility
Monitoring Therapy:
  • respiratory rate
  • BP
  • PWP (for use with pulmonary edema)
  • abdominal distension, bowel sounds
  • analgesic response
  • bowel sounds
CCTC Protocol:
  • May be administered IV direct by an approved nurse in CCTC providing no more than 10mg per dose, and final concentration does not exceed 2mg/ml.
  • Continuous infusion must be administered via an infusion pump.

Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017

LHSCHealth Professionals

Last Updated January 12, 2017 | © 2007, LHSC, London Ontario Canada