▶Child 1 year:Initially 200 – 300 micrograms/kg every
4 hours, adjusted according to response
▶Child 2–11 years:Initially 200 – 300 micrograms/kg every
4 hours (max. per dose 10 mg), adjusted according to
response
▶Child 12–17 years:Initially 5 – 10 mg every 4 hours,
adjusted according to response
▶BY CONTINUOUS SUBCUTANEOUS INFUSION
▶Child 1–2 months: 10 micrograms/kg/hour, adjusted
according to response
▶Child 3 months–17 years: 20 micrograms/kg/hour,
adjusted according to response
Pain (with modified-release 12 -hourly preparations)
▶BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶Child:Every 12 hours, dose adjusted according to daily
morphine requirements, dosage requirements should
be reviewed if the brand is altered
Pain (with modified-release 24 -hourly preparations)
▶BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶Child:Every 24 hours, dose adjusted according to daily
morphine requirements, dosage requirements should
be reviewed if the brand is altered
Neonatal opioid withdrawal (under expert supervision)
▶BY MOUTH
▶Neonate:Initially 40 micrograms/kg every 4 hours until
symptoms controlled, dose to be increased if necessary;
reduce frequency gradually over 6 – 10 days, stop when
40 micrograms/kg once daily achieved, dose may vary—
consult local guidelines.Persistent cyanosis in congenital heart disease when
blood glucose less than 3 mmol/litre (following glucose)
▶BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR
INJECTION
▶Child: 100 micrograms/kg
DOSE EQUIVALENCE AND CONVERSION
▶The doses stated refer equally to morphine
hydrochloride and sulfate.lUNLICENSED USE
▶With oral useOramorph®solution andMXL®capsules not
licensed for use in children under 1 year.Sevredol®tablets
not licensed for use in children under 3 years.Oramorph®
unit dose vials andFilnarine®SR tablets not licensed for
use in children under 6 years.MST Continus®preparations
licensed to treat children with cancer pain (age-range not
specified by manufacturer).
▶With rectal useSuppositories are not licensed for use in
children.
IMPORTANT SAFETY INFORMATION
Do not confuse modified-release 12 -hourly preparations
with 24 -hourly preparations, seePrescribing and
dispensing information.lCONTRA-INDICATIONSAcute abdomen.delayed gastric
emptying.heart failure secondary to chronic lung disease.
phaeochromocytoma
lCAUTIONSCardiac arrhythmias.pancreatitis.severe cor
pulmonale
lINTERACTIONS→Appendix 1 : opioids
lSIDE-EFFECTS
▶Common or very common
▶With oral useAppetite decreased.asthenic conditions.
gastrointestinal discomfort.insomnia.neuromuscular
dysfunction
▶Uncommon
▶With oral useAgitation.bronchospasm.ileus.mood
altered.myoclonus.paraesthesia.peripheral oedema.
pulmonary oedema.seizure.syncope.taste altered
▶Frequency not known
▶With oral useAmenorrhoea.biliary pain.cough decreased.
hyperalgesia.hypertension.pancreatitis exacerbated.
sexual dysfunction.thinking abnormal.ureteral spasm
▶With parenteral useAlertness decreased.bile duct disorders
.contact dermatitis.mood altered.myoclonus.postural
hypotension.sexual dysfunction.ureteral spasm.urinary
disorders.vision disorders
lBREAST FEEDINGTherapeutic doses unlikely to affect
infant.
lRENAL IMPAIRMENTAvoid use or reduce dose; opioid
effects increased and prolonged; increased cerebral
sensitivity.
lDIRECTIONS FOR ADMINISTRATION
▶With intravenous useForcontinuous intravenous infusion,
dilute with Glucose 5 %or 10 % or Sodium Chloride 0. 9 %.
▶With intravenous use in neonatesNeonatal intensive care,
dilute 2. 5 mg/kg body-weight to afinal volume of 50 mL
with infusionfluid; an intravenous infusion rate of
0. 1 mL/hour provides a dose of 5 micrograms/kg/hour.
▶With oral useFormodified release capsules—swallow whole
or open capsule and sprinkle contents on soft food.
lPRESCRIBING AND DISPENSING INFORMATIONModified-
release preparations are available as 12 -hourly or
24 -hourly formulations; prescribers must ensure that the
correct preparation is prescribed. Preparations that should
be given 12 -hourly includeFilnarine®SR,MST Continus®,
Morphgesic®SRandZomorph®. Preparations that should
be given 24 -hourly includeMXL®.
Prescriptions must specify the‘form’.
▶With rectal useBoth the strength of the suppositories and
the morphine salt contained in them must be specified by
the prescriber.
lPATIENT AND CARER ADVICEPatients or carers should be
given advice on how to administer morphine modified-
release capsules.
Medicines for Children leaflet: Morphine for pain
http://www.medicinesforchildren.org.uk/morphine-for-pain
lEXCEPTIONS TO LEGAL CATEGORY
Morphine Oral SolutionsPrescription-only medicines or
schedule 2 controlled drug. The proportion of morphine
hydrochloride may be altered when specified by the
prescriber; if above 13 mg per 5 mL the solution becomes a
schedule 2 controlled drug. It is usual to adjust the
strength so that the dose volume is 5 or 10 mL.
Oral solutions of morphine can be prescribed by writing
the formula:
Morphine hydrochloride 5 mg
Chloroform water to 5 mLlMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: capsule, oral solution, solution for
injection, infusion, solution for infusion, suppository
Modified-release tablet
CAUTIONARY AND ADVISORY LABELS2, 25
▶MST Continus(Napp Pharmaceuticals Ltd)
Morphine sulfate 5 mgMST Continus 5 mg tablets| 60 tabletP
£ 3. 29 DT = £ 3. 29 b
Morphine sulfate 10 mgMST Continus 10 mg tablets|
60 tabletP£ 5. 20 DT = £ 5. 20 b
Morphine sulfate 15 mgMST Continus 15 mg tablets|
60 tabletP£ 9. 10 DT = £ 9. 10 b
Morphine sulfate 30 mgMST Continus 30 mg tablets|
60 tabletP£ 12. 47 DT = £ 12. 47 b
Morphine sulfate 60 mgMST Continus 60 mg tablets|
60 tabletP£ 24. 32 DT = £ 24. 32 b
Morphine sulfate 100 mgMST Continus 100 mg tablets|
60 tabletP£ 38. 50 DT = £ 38. 50 b
Morphine sulfate 200 mgMST Continus 200 mg tablets|
60 tabletP£ 81. 34 DT = £ 81. 34 bBNFC 2018 – 2019 Pain 283
Nervous system4