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Author: Admin | 2025-04-28
Control symptoms of dyspnea and pain (di Pede 2018).ReconstitutionParenteral:IV push/intermittent infusion: May dilute to a final concentration of 0.5 to 5 mg/mLContinuous IV infusion: Dilute in D5W, D10W, or NS to a usual final concentration of 0.1 to 1 mg/mL; more concentrated solutions may be used in patients requiring fluid restriction or high doses (Murray 2014; Sinclair-Pingel 2006); concentrations >5 mg/mL are rarely needed (Gahart 2014).Epidural and intrathecal: Use only preservative-free injections indicated for epidural/intrathecal use. Dilution may be required (preservative-free NS recommended); determined by the individual dosage requirements and the characteristics of the continuous microinfusion device; filter through ≤5 micron microfilter before injecting into microinfusion device.Extemporaneously Prepared0.4 mg/mL (400 mcg/mL) Oral Solution (ASHP 2017)A 0.4 mg/mL oral solution may be made using the 2 mg/mL oral morphine solution. Measure 10 mL (20 mg) of the 2 mg/mL oral morphine solution and transfer to a plastic amber bottle. Measure 40 mL of sterile water for irrigation and add to bottle containing the morphine. Shake to mix. Store at room temperature. Stable for 60 days.Sauberan J, Rossi S, Kim JH. Stability of dilute oral morphine solution for neonatal abstinence syndrome. J Addict Med. 2013;7(2):113-115.23370932AdministrationOral: Do not crush, chew, or dissolve ER formulations; swallow whole. Cutting, breaking, crushing, chewing, or dissolving ER formulations may result in uncontrolled delivery of morphine, leading to overdose and death.Arymo ER: Swallow tablets whole, one tablet at a time, with enough water to ensure complete swallowing immediately after placing in the mouth; do not pre-soak, lick, or wet tablets prior to placing in the mouth.Kadian: Capsules may be opened and sprinkled on applesauce and eaten immediately without chewing; do not crush, dissolve, or chew the beads, as it can result in a rapid release of a potentially fatal dose of morphine. Ensure all pellets have been swallowed by rinsing mouth. Contents of capsules may be opened and sprinkled over 10 mL water and flushed through prewetted 16F gastrostomy tube; do not administer through gastric/nasogastric tubes.IV: Administer single-use prefilled syringes/cartridges via slow IV push over 4 to 5 minutes (rapid administration may result in chest wall rigidity). Concentrated vials are available for preparation of continuous IV infusion or PCA; refer to indication-specific infusion rates in dosing for detailed recommendations.Epidural, intrathecal: Use only preservative-free solutions indicated for intrathecal or epidural use; refer to indication-specific infusion rates in dosing for detailed recommendations.Rectal: Remove suppository from plastic packet and moisten suppository with water to avoid irritation. Gently insert (rounded end first) approximately a finger's length into rectum, angling it toward the umbilicus, and placing it against the rectal wall; after suppository is inserted, hold buttocks together until urge to expel ceases (Pasero 1999). Dietary ConsiderationsMorphine may cause GI upset; take with food if GI upset occurs. Be consistent when taking morphine with or without meals. StorageParenteral: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Do not freeze. Store in carton until use. Protect from light. Degradation depends on pH and presence of oxygen; relatively stable in
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