Morphine or, in other words, Morphine in its pure form is presented in the form of a white powder. In addition to the sedative and hypnotic effect on the body, morphine is used for cancer pain relief. How to use the medicine correctly and what are the features of its use?

General characteristics of cancer pain and features of the use of drugs for cancer

Malignant tumors are one of the most dangerous pathologies in modern medicine. Dangerous consequences are expressed not only in a possible fatal outcome, but also in the occurrence of severe intractable pain, which brings a lot of suffering to a person. Every person suffering from a malignant neoplasm of any localization, at every stage of its development, is faced with pain syndrome.

Often, severe pain occurs in stage 4 cancer, when metastases are observed, radiating from the primary focus to other organs and systems. At this time, the doctor takes all measures to relieve the intensity of the pain and the general well-being of the patient. According to research data, almost half of all cancer patients do not have complete control over the symptom, and a quarter of them die not from the malignant lesion of the body itself, but from unbearable pain syndrome.

Before you understand how morphine works in pain relief of a malignant tumor, it is worth considering what is the mechanism of pain in this case and how it occurs. So, in order to determine the necessary method for managing a symptom in cancer, first of all, find out the type of pain:

1. Nociceptive. Pain impulses from nociceptors to the brain are transmitted via peripheral nerves. Nociceptive pain, in turn, is subdivided into somatic (acute or dull), visceral (not clearly defined) and associated with previous invasive surgery.
2. Neuropathic. The pain syndrome in this case is caused by damage nervous system... If a person is diagnosed with cancer in any progression stage, neuropathic pain may be caused by nerve root infiltration, chemotherapy drug, or radiation therapy.

Over time, the progression of the oncological disease, the pain syndrome only intensifies in its intensity, reaching maximum rates when the disease reaches stage 4. The most effective is the use of Morphine for cancer, which began to be used for such purposes back in 1950. Later, the World Health Organization decided to take this drug every 4 hours to achieve the desired pain relief.

In those years, morphine was used only in tablet form for the development of cancer. Today, there are also injections (injections) of the drug. Excretion from the body of different forms of morphine release occurs over a different period of time. The injectable form of the drug has an immediate release and rapid absorption. For this reason, Morphine injections can be taken several times a day. If we talk about the tablet form of the drug, its excretion from the body is rather slow, which makes it possible to use Morphine only once a day.

Internal use of morphine helps relieve moderate to severe pain. If used correctly, the medicine is quite safe and effective. Otherwise, especially with the abuse of the drug, addiction and respiratory depression can be caused.

The use of morphine for cancer has its own characteristics:

1. Individual determination of the dosage of the medication, taking into account the intensity and nature of the pain.
2. The exact time of taking Morphine in the development of cancer, which is determined by the attending physician based on the individual characteristics of the development of pathology.
3. "Upward" drug use, namely, from the maximum dosage of low-potency opiates to the minimum dosage of Morphine.
4. The most gentle and effective forms of medication are considered tablets, but when used correctly, in order to avoid addiction.

To eliminate the pain caused by the development of a malignant tumor, tablets are taken at a rate of 0.2-0.8 mg / kg, every 12 hours.The granules of the drug, which are intended for suspension and internal use, are prepared as follows: 20, 30 or 60 mg of granules are diluted in 10ml of water, 100mg - in 20ml, 200mg - in 30ml. The suspension must be mixed well and drunk immediately after preparation. The dose for one injection of Morphine is 1 mg. In this case, the drug is administered subcutaneously. You can inject the medicine into a vein or muscle, but at a different dosage - 10 mg.

Under what circumstances is it forbidden to use the medicine

In addition to such a high efficiency of Morphine used in malignant neoplasms, there are contraindications, which are absolute and relative. The first type includes:

• the course of pathologies in the body that cause depression of the central nervous system or respiration;
• development of intestinal obstruction;
• systematic convulsions;
• frequent increase in intracranial pressure;
• trauma to the skull in the past;
• psychosis due to alcohol dependence or other acute alcoholic pathology;
• the development of bronchial asthma, cardiac arrhythmias, heart failure caused by chronic pulmonary disease;
• heavy general state, which is observed after surgery on the biliary tract;
• the development of pathologies of the abdominal organs requiring surgical intervention;
• concomitant use of monoamine oxidase inhibitors (ban on the use of morphine for two weeks after the end of their intake);
• individual intolerance to the components of morphine.

Relative contraindications for taking a drug for cancer are:

• the course of chronic obstructive pulmonary disease;
• suicidal tendencies in the patient;
• alcohol addiction;
• development of gallstone disease;
• epilepsy;
• operations that were previously performed on the digestive tract or urinary tract;
• development of renal or hepatic failure;
• the development of hypothyroidism;
• in men - the course of prostatic hyperplasia;
• the course of severe intestinal pathology of an inflammatory nature.

It is also worth taking Morphine carefully for elderly people and children. In such cases, the medicine is prescribed only by a specialist and taking into account the peculiarities of the course of oncological pathology. During pregnancy and lactation, the drug is used in case of emergency.

Side symptoms and overdose

Side effects can occur from many organs and systems in the body. If you take Morphine incorrectly, without the consent of your doctor or in violation of his recommendations, you can cause the following negative manifestations:

• on the part of the central nervous system and sensory organs: headaches, dizziness, a feeling of constant anxiety, apathy towards people around, nightmares that disappear at night, paresthesias, increased intracranial pressure, muscle twitching, inability to coordinate movement, convulsive syndrome, disturbance of the visual system (clouding before the eyes), violation taste sensations, the appearance of ear ringing;
• on the part of the cardiovascular system: the development of bradycardia, tachycardia, heart rhythm disturbance, decreased or increased arterial pressure fainting;
• from the respiratory system: bronchospasm, the development of atelectasis;
• from the digestive system: nausea, constipation or diarrhea, vomiting, the development of gastralgia, anorexia, cholestasis, spasms;
• on the part of the urinary tract: a decrease in the volume of daily urine output, spasms of the ureters, a disturbed process of excretion of urine from the body;
• allergies: redness of the skin of the face, swelling of the face or trachea, general malaise, skin rashes, itching syndrome.

Exceeding the dosage of the medication can cause the following signs of an overdose:

• increased cold sweating;
• clouding of consciousness;
• general malaise;
• increased nervous excitement;
• heart rhythm disorder;
• anxiety syndrome;
• signs of psychosis;
• increased intracranial pressure;
• muscle weakness;
• convulsions;
• coma.

If there are similar symptoms of an overdose, carry out the necessary resuscitation measures.

Special instructions while taking the medicine

Special instructions that should be followed when prescribing and during the period of direct administration of the drug include:

1. If there is a risk of developing intestinal obstruction, the medication must be stopped.
2. If it is necessary to carry out surgery on the heart or other with severe pain, Morphine is finished taking the day before.
3. If nausea or vomiting occurs while taking the drug, the combined use of phenothiazine is allowed.
4. To reduce the side effect of the drug on the intestines, the use of laxatives is recommended.
5. Driving motor vehicles during the period of morphine treatment must be carried out with caution, as well as engaging in activities requiring increased attention.
6. The joint intake of antihistamines, hypnotics and psychotropic drugs, that is, those that affect the central nervous system, are recommended to be discussed with the attending physician.

No doctor will tell you exactly how long this or that person suffering from a malignant neoplasm of any localization will live. It all depends not so much on the individual characteristics of the organism as on the timeliness of the appointment of the appropriate treatment. For this reason, in order to avoid the use of such a strong drug as Morphine, it is recommended to consult a doctor at the first symptoms of the disease, when it occurs at the initial stage.

What is morphine and where is it used? Unprocessed medicinal product"Morphine" looks like a white crystalline powder. "Morphine" is an outdated name for the drug. The name of this substance refers to the Greek god Morpheus, who, according to legends, ruled over dreams. It is a drug that is an alkaloid of opium. It is made from processed opium poppy juice. In addition, small amounts of morphine can be found in herbs like Stephanie, Sinomenium, Moonseed, etc. What is morphine, we will consider below.

History reference

Morphine is a drug that has sedative, analgesic, sedative and hypnotic effects. The drugs developed on the basis of morphine have been used in medical practice since 1805. All hospitals during civil war in the United States were supplied with this drug. It was administered to wounded soldiers as an anesthetic intramuscularly or intravenously after surgery, which greatly facilitated the fate of patients. That's what morphine is. The content of this concept is of interest to many.

The main disadvantage

The main drawback of the drug was its narcotic nature. This caused a quick addiction during use. Soon enough, the state into which the patient was driven by prolonged use of the drug began to be called a soldier's disease. It is also a well-known fact that at the beginning of the 20th century, the drug was used not only for military purposes, but also by doctors, who thus wanted to suppress the feeling of fatigue. Not everyone knows what morphine is and what the properties of the substance are.

Form and properties

The drug comes in several forms. Morphine can be in tablets and solutions for intramuscular or intravenous administration. As for the properties of the drug, there are several characteristic features:

1. Morphine is produced in the form of needle crystals or powder white... It tends to turn yellow or gray during long-term storage.

2. In water, the drug is diluted slowly, and it is almost impossible to dissolve it in an alcohol solution.

3. Incompatibility with alkalis.

4. A solution with morphine requires a half-hour sterilization at a temperature of 100 degrees Celsius.

5. Hydrochloric acid is added to stabilize the solution.

6. The powder melts at 254 degrees Celsius.

7. The specific value of the solution rotation is 2%.

8. Ignition occurs at 261 degrees.

9. Powder ignites spontaneously at 349 degrees Celsius.

Consider the instructions for morphine briefly.

Pharmacodynamics

Morphine belongs to the category of narcotic drugs. It is included in the group of opioid analgesics. The drug can induce euphoria, create a sense of peace of mind, reduce pain, improve mood and show bright prospects, even if the actual state of affairs leaves much to be desired.

Addictive

Similar properties of morphine and provoke the development of mental and even physical dependence on the drug. If the dosage is exceeded, it becomes a powerful hypnotic. In addition, the substance is able to slow down the speed of conditioned reflexes, reduce the excitability of the cough center and cause miosis. Also, the drug increases the muscle tone of internal organs, which can cause spasm of the sphincter of Oddi, as well as the biliary tract. Another property of the drug is the weakening of intestinal peristalsis. In this case, there is an acceleration of emptying and an increase in gastric peristalsis.

What is morphine and what is it for?

As an anesthetic, it is prescribed subcutaneously, intravenously or intramuscularly. However, other uses are possible, for example, orally, rectally, epidurally, or intrathecally, that is, under the lining of the spinal cord.

The drug is absorbed very quickly. Up to 40% of the active substance binds to plasma proteins. Morphine is able to cross the placenta and inhibit the respiratory function of the fetus. The same goes for breast milk... That is, it is categorically impossible to use during pregnancy and lactation. When administered intramuscularly, the peak of the drug's efficacy is achieved after 15 minutes. Distribution through the bloodstream occurs after 35 minutes, and the effect lasts up to 5 hours.

Indications for use

Morphine is prescribed as a pain reliever for injuries and diseases accompanied by significant pain. It is also used during preparatory procedures before and after surgery. Sometimes the drug can be prescribed for strong cough and shortness of breath, insomnia and other symptoms accompanying acute heart failure.

During the X-ray

In some cases, it is allowed to use morphine during an X-ray examination of the gallbladder, stomach or duodenum. The drug helps to increase the muscle tone of the stomach, enhances peristalsis and accelerates the process of emptying. All this makes it easier for specialists to diagnose oncological diseases of internal organs or ulcers.

Oncology and other fields of application

The main field of application of morphine is oncology. The drug is able to quickly relieve pain and ease the patient's condition. Thus, this drug has the following properties:

1. Oppression of painful sensations in cancer, trauma, unstable angina and myocardial infarction.

2. It is used in the field of anesthesiology during the operation as an additional tool.

3. If other drugs are ineffective, morphine is used during childbirth, for coughing or pulmonary edema.

4. Discharged before the X-ray of the gallbladder, stomach or duodenum. We have explained what morphine is.

Contraindications

Contraindications for taking morphine are:

1. Increased sensitivity to the components of the drug.

2. Depression of respiratory function, for example, as a result of alcohol or drug intoxication.

3. Suppressed state of the central nervous system.

4. Intestinal obstruction of a paralytic type.

5. Conducting epidural or spinal anesthesia.

Carefully

These are absolute contraindications. There are also situations where morphine should be used with extreme caution. It can be:

1. Pain in the abdomen of unexplained genesis.

2. Lability of the emotional plan.

3. Attack of bronchial asthma.

4. Arrhythmia.

5. Convulsions.

6. The presence of drug dependence.

7. Alcoholism.

8. Suicidal tendencies.

9. Gallstone disease.

10. Carrying out surgical intervention in the organs of the gastrointestinal tract and urinary system.

Also, the use of the drug requires caution in case of brain trauma, hepatic or renal failure, prostatic hyperplasia, hypothyroidism, urethral stricture, inflammatory bowel disease in severe form, epileptic syndrome, as well as after surgery in the biliary tract.

This is what morphine is in medicine.

Dosage

Morphine and its derivatives are included in list I and II drugs. For this reason, some of the drugs are in strictly limited access, and some of them are prohibited for sale in Russia. However, morphine-based drugs are still used in hospitals. It can be used only as directed by a doctor and in the dosage indicated by a specialist. The latter depends on the severity of the patient's condition and the sensitivity of his body to the drug.

What is morphine and what is it for - patients often ask.

A single dosage for an adult patient is 10-20 mg, when it comes to capsules, then one dose is up to 100 mg. With intramuscular and intravenous administration, the dosage is 10 mg, while 50 mg per day should not be exceeded.

Side effects

If the dosage prescribed by the doctor is exceeded, the patient may experience a number of side effects, such as:

1. Confusion of consciousness.

2. Cold and clammy, profuse sweat.

3. Fatigue.

4. Sleepiness.

6. Bradycardia.

7. Intracranial hypertension.

8. Nervousness.

9. Hypothermia.

10. Slowdown and difficulty in breathing.

11. Anxiety.

12. Dry mouth.

13. Delirious psychosis.

14. Lowering blood pressure.

15. Dizziness.

16. Convulsions.

17. Hallucinations.

18. Muscular rigidity.

It is important not only to know what morphine is, but also to understand the following. Dependence on it can become a serious illness that requires the immediate intervention of the appropriate specialists. This is due to the fact that addiction can cause severe overdose, the result of which may well be fatal.

Morphine is an opiate, a substance derived from the opium poppy, a narcotic drug. It is also an inexpensive and effective analgesic. It is in demand in many areas of medicine, and especially in oncology.

When conventional non-narcotic pain relievers no longer help relieve the suffering of the dying, morphine comes to the rescue. But this drug is not only beneficial, it can be dangerous if used incorrectly.

Therefore, it is so important to know what morphine is, when it can be used and what the risk of errors in treatment.

Morphine was first studied as far back as 1804. Friedrich Sertürner, who discovered it, noticed the effect of the drug and therefore named it after Greek god Morpheus, responsible for dreams.

But when taken orally, its effectiveness is low, therefore, the medicine began to be widely used only 50 years after the invention of the injection needle. It was then that the analgesic effect of this substance was discovered.

Morphine is an alkaloid extracted from the opium poppy. There it is found in the form of salts of lactic, meconic and sulfuric acids. You can get it from opium - the frozen juice of the unripe heads of the opium poppy. For this, cuts are made on the heads, through which valuable juice is released.

Morphine is also found in small amounts in other plants of the poppy family, as well as in moonseeds and ocotea. But there it is not enough, therefore plants have no industrial value.

Pharmacists classify morphine as narcotic analgesics. It affects the human nervous system, thus suppressing the feeling of pain. The main actions of morphine are manifested in:

• Violation of the advancement of pain and sensory impulses along the nerve entrances due to the activation of a special endogenous antinociceptive system.
• Changing the very perception of pain, by acting on the right centers in the brain.

Morphine stimulates opium receptors, which are located in the brain and spinal ganglia, as well as in the vagus nerve, myocardium and nerve plexus of the stomach. This leads to disruption of their metabolism at the biochemical level.

How does morphine affect the human body?

After the introduction of the drug, important changes begin in the human body. The main actions of morphine:

• Strong analgesic effect, allowing you to dull sensations even at the last stage of cancer;
• Anti-shock effect caused by a decrease in the excitability of pain centers;
• Slowing down of the heart rate due to the effect on the vagus nerve;
• Decrease in the excitability of the cough center of the brain and, as a result, "turn off" the cough;
• Hypnotic effect after taking large doses of the drug;
• Increased tone of smooth muscles, including in the genitourinary and biliary tract, as well as the sphincters of the gastrointestinal tract.
• Decrease in gastric acid secretion;
• Depression of the respiratory center;
• Increased bronchial tone;
• Decrease in the rate of metabolic processes in the body and temperature;
• Suppression of the gag reflex.

In addition, with long-term and / or frequent use, this opiate is addictive. It will not work just like that, as the withdrawal syndrome will begin. Therefore, it is prescribed only when there are no safer alternatives.

Usually morphine is injected under the skin. When taken orally, its bioavailability is low - about 26%. When administered intravenously, it is absorbed too intensively and after 10 minutes it almost completely disappears from the systemic circulation. 90% of the drug is broken down in the liver.

Indications for the appointment of morphine

In modern medicine, it is commonly used as a pain reliever. Most often, it is prescribed to patients with cancer, since other medications cannot relieve unbearable pain. You can also use the drug when:

• Severe injuries to prevent pain shock;
• Myocardial infarction to prevent cardiogenic shock;
• Severe attacks of angina pectoris;
• Preparing for and after surgery as a pain reliever.

In addition, morphine can be used as an adjunct to epidural and spinal anesthesia.

This drug is dangerous, as it has a toxic effect on the entire human body. That is why the scope of its application is not wide. In addition to the formation of dependence on the drug, morphine can lead to side effects there:

• From the gastrointestinal tract - nausea with vomiting, as well as diarrhea or constipation. Sometimes there is a spasm of the biliary tract and intestinal obstruction due to intestinal paralysis.
• From the side of the cardiovascular system - tachycardia, a decrease in blood pressure, a change in heart rate depending on the dose of the drug, damage to the coronary vessels.
• On the part of the genitourinary system - pain and difficulty urinating, decreased libido and potency, aggravation of the symptoms of prostate adenoma.
• From the respiratory system - bronchospasm and respiratory depression;
• From the nervous system - anxiety, confusion, delirium and hallucinations, impaired cerebral circulation due to increased intracranial pressure and convulsions.

Development is also possible allergic reactions, although this rarely happens. About one in a thousand patients has mild itching, and more dangerous reactions are much less common.

It is very important to remember about the embryotoxic effect of morphine. It leads to damage to the fetal nervous system and immunity. Children of mothers using this drug are born sickly and lightweight.

Although the list of such actions is daunting, morphine is actually safer than many pain relievers. Minor discomfort, which is quite possible after the first few doses, gradually fades away. If necessary, drugs can be prescribed to relieve the unpleasant symptom.

Contraindications

Morphine is not indicated for opiate sensitivity. Also contraindications to the use of the drug are:

• Abdominal pain of unknown origin;
• Increased intracranial pressure and traumatic brain injury;
• Renal failure;
• Epilepsy and coma;
• Age up to 2 years.

Morphine is not used as a pain reliever during childbirth, as it can depress the respiratory center. Particular care is required when using the drug in patients with obstructive pulmonary diseases, bowel and urinary tract diseases, alcoholism, emotional lability and suicidal tendencies.

The use of morphine in cancer patients

Modern doctors, guided by decrees of the Ministry of Health, try to get by with lighter, non-narcotic drugs to the last. It is recommended to prescribe morphine to patients only at the third stage of cancer, when the pain becomes unbearable. Most often in such a situation, "Morphine hydrochloride", "Morphine sulfate" or "Morphine" are prescribed.

The dosage form of the drug and the dosage are determined by the doctor. This is done gradually, starting with the minimum dose and gradually increasing it until the required analgesic effect is achieved. They take the medicine by the hour, and not focusing on their well-being. Usually morphine is injected under the skin so it is absorbed more evenly. It is also sometimes practiced to use the drug in the form of tablets and capsules or a patch.

Why is morphine dangerous?

Morphine is a very necessary and important medicine, but if used incorrectly or uncontrolled, it can pose a significant danger. The drug relieves pain, while it gives a feeling of comfort and calmness, often causes euphoria and instills confidence in the best prospects, even if the patient does not have them.

I want to repeat this pleasant feeling over and over again. So even those who are prescribed morphine according to indications may develop mental dependence, and then physical.

Gradually, the severity of sensations decreases, as does the analgesic effect. The patient needs an increase in dose. If you do this too quickly, it is easy to exceed the volumes considered fatal to healthy person... Of course, people who are used to morphine have a higher tolerance, but high dosages are still dangerous.

Why does morphine poisoning happen?

Acute overdoses of morphine and other opiates are most common in drug addicts. They are trying to get more sensation and injecting too much of the substance. It is also possible to use morphine for the purpose of suicide, but this happens less often. Poisoning with the drug is also possible during its therapeutic use, for example:

• With the wrong dosage;
• If taken too often;
• Due to the incorrectly chosen method of drug administration;
• When treating young children;
• With the wrong prescription of the medicine.

In a healthy adult, the lethal dose of morphine is 0.2 grams when administered intravenously and 0.5-1 when taken orally. With morphinism, the lethal dose is increased to 3-4 grams. Equally murderous is the use of the drug in any form.

Symptoms of morphine poisoning increase gradually. Immediately after taking the drug, the victim begins euphoria and a whole bunch of pleasant sensations. But this is not always the case.

If this is the first use of an opiate, dysphoria, depression and anxiety may occur on the contrary. Then other symptoms appear:

• Restlessness and dry mouth;
• Worsening headache, which may be accompanied by nausea and vomiting;
• Increased urge to urinate;
• The appearance of cold, clammy sweat;
• Salivation;
• An increase in drowsiness, gradually turning into a stupor and coma;
• Constriction of the pupils immediately after taking the drug and their significant expansion in the last stages with severe hypoxia;
• Seizures;
• Strong slowing of breathing up to 1-5 times per minute.

Morphine poisoning is often accompanied by delirious psychosis. The victim may become disoriented, experience hallucinations and delusional experiences.

If the antidote to morphine is not administered in time, paralysis of the respiratory center occurs, which leads to death.

How to give first aid to a morphine victim

If the drug was injected, it is almost impossible to do something on your own. It is necessary to call doctors immediately. If the victim is unconscious, cardiopulmonary resuscitation can be done. If the poisoned person reacts to you, you need to talk to him, lightly pat on the cheeks, pinch the earlobes, try to constantly talk to keep him awake.

In case of poisoning with pills, doctors are also needed, but while waiting for them, you can try to help:

• Rinse the stomach with plain water, causing vomiting by pressing on the root of the tongue;
• Take a saline laxative to cleanse the intestines;
• Take enterosorbent.

It is prohibited to take any drugs other than sorbents and a saline laxative, since morphine interacts with many drugs and can increase their toxicity. Doctors for the treatment of morphine poisoning use a specific antidote - Naloxone or Nalorphine. Sometimes cardiac stimulants are required. Bladder catheterization is also done due to urinary tract spasm.

Morphine poisoning can cause unpleasant consequences, such as the addition of an infection of the respiratory system, edema of the lung and brain, coma.

Prevention of morphine poisoning

To avoid poisoning with this dangerous opiate, you must:

• Never take it without a doctor's prescription;
• Always observe the dosage and frequency of administration;
• Do not take other drugs that act on the central nervous system, unless prescribed by the doctor;
• In case of side effects, inform your doctor immediately;
• Always keep medicines out of the reach of children.

Morphinism

Morphinism is an addiction to the opiate morphine. Even with a very moderate intake, it causes an improvement in mood and euphoria. But over time, to obtain the same effect, the dose has to be increased, and withdrawal from the drug causes withdrawal symptoms.

The state of health and condition of the morphine addict sharply deteriorates and he is forced to take a new dose, no longer for pleasure, but to avoid "withdrawal".

In the 19th century, morphine was a very popular pain reliever that was widely used to treat soldiers during military conflicts. Therefore, almost half of the military turned out to be dependent on the drug. In 1879, morphinism was even called a soldier's disease.

In the first half of the 20th century, many doctors became morphine addicts. It was believed that knowing about the harmful effects of taking the drug, you can avoid a sad fate. Many doctors thought so, until it became clear that drug addiction does not spare anyone. Therefore, today the circulation of morphine is strictly controlled. Doctors prescribe it only according to indications and if no other analgesic already helps. Illegal drug trafficking is a criminal offense.

1 ml of solution contains 10 mg of active substance according to INN - morphine hydrochloride .

1 capsule of prolonged action contains 10 mg of morphine.
Morphine Formula: C17-H19-N-O3.

Release form

The solution is available in 1 ml ampoules. A pack of cardboard contains 1 cell package (for 5 ampoules) and instructions from the manufacturer.

Prolonged capsules are produced in cardboard boxes (10 pieces per package).

pharmachologic effect

What is Morphine?

Morphine is opioid pain reliever , drug ... According to the mechanism of action, the drug belongs to the agonists of opioid receptors. The drug has anti-shock action , reduces the excitability of pain centers. The hypnotic effect is manifested with the appointment of high dosages.

The active substance increases the tone of the sphincters, smooth muscle of the bronchi and internal organs, reduces the excitability of the cough center, inhibits conditioned reflexes, causes bradycardia ... The drug tones the sphincters of the bladder, biliary tract; inhibits the respiratory center, lowers body temperature, slows down metabolism, suppresses the secretory activity of the digestive system, stimulates the production of ADH.

Effects on the brain

Excitation of trigger chemoreceptor zones in the medulla oblongata leads to the activation of the gag reflex. After subcutaneous administration, the medication begins to take effect after 10-15 minutes. The effective action of prolonged-release capsules is recorded in 20-30 minutes.

Pharmacodynamics and pharmacokinetics

After subcutaneous administration and taking capsules inside, the drug is rapidly absorbed and enters the systemic circulation. When taken orally, the absorption rate reaches 80%. For the drug, the nature of the effect of "first pass" through the hepatic system. Due to the conjugation with glucuronides, it is complete in the liver.

The half-life is 2-3 hours. The main route of excretion of metabolites is through the renal system (90%). An insignificant part (about 10%) is displayed with. For elderly patients, an increase in the T1 / 2 index is characteristic (similarly with pathology of the renal system and liver).

Indications for use

What is morphine? It is a narcotic analgesic prescribed to relieve severe pain syndrome with:

• traumatic injuries;
• malignant neoplasms;
• surgical interventions;

The drug can be prescribed for severe shortness of breath, provoked by insufficiency of the cardiovascular system; with a cough that cannot be stopped with antitussive medications.

Contraindications

• traumatic brain damage;
• respiratory failure due to depression of the respiratory center;
• severe general depletion of the body;
• severe pain in the epigastric region of unknown origin;
• delirium;
• epistatus;
• hepatic cell failure;
• treatment with MAO inhibitors;
• age limit - up to 2 years.

Side effects

Urinary tract:

Violation of urine flow with urethral stenosis,.

The cardiovascular system:

Rare pulse, bradycardia.

Digestive tract:

• cholestasis of the main bile duct;
• vomit;
• nausea;

Nervous system:

• increased intracranial pressure with a high risk of development;
• stimulating effect;
• sedation;
• development ;
• delirium.

Morphine, application instruction (Way and dosage)

Instructions for the use of Morphine hydrochloride

Individual dosage regimen. 1 mg is injected subcutaneously once. Further dose selection is carried out based on the severity of the pain syndrome.

Taking capsules

Every 12 hours, 10-100 mg, depending on the desired therapeutic effect. For children from 2 years of age, a single dosage is 1-5 mg.

Overdose

Poisoning is manifested by a kind of clinical picture (acute and chronic overdose):

• clammy, cold sweat;
• fatigue;
• the fall ;
• confusion of consciousness;
• labored, slow breathing;
• bradycardia;
• miosis;
• pronounced;
• bradycardia;
• delirious psychosis;
• dry mouth;
• anxiety;
• intracranial hypertension;
• cessation of breathing;
• muscle rigidity;
• coma.

Treatment

A specific antagonist is injected urgently intravenously - at a dose of 0.2-0.4 mg. After 2-3 minutes, the injection is repeated until the total amount of the administered drug is 10 mg.

In pediatrics, the initial dosage of Naloxone is 0.01 mg / kg. Measures are being taken to stabilize blood pressure, restore the functioning of the respiratory system and heart.

Interaction

Strengthens the sedative, hypnotic effect of anxiolytics and anesthetics (general, local). The simultaneous administration of narcotic painkillers and barbiturates can lead to a pronounced suppression of an active brain, the development arterial hypotension , respiratory depression.

The effect of opioid analgesics is reduced with the systematic use of other barbiturates (cross-tolerance is characteristic). Therapy with MAO inhibitors can negatively affect the functioning of the cardiovascular system. Development is possible myoclonus in cancer patients during treatment.

R N001645 / 02-170909

Tradename: Morphine

INN or grouping name: Morphine &

Chemical rational name:(7,8-dehydro-4,5alpha-epoxy-17-methylmor-finance-3,6-alpha-diol) hydrochloride

Dosage form:

solution for subcutaneous administration

Compound:

1 ml of solution contains:
active substance- morphine hydrochloride in terms of anhydrous substance - 8.56 mg
Excipients- disodium edetate (disodium salt of ethylenediaminetetraacetic acid), glycerol (distilled glycerin), hydrochloric acid solution 0.1 M, water for injection.

Description: clear colorless or yellowish liquid.

Pharmacotherapeutic group:

analgesic narcotic

ATX code:
Belongs to Schedule II of the List of narcotic drugs, psychotropic substances and their precursors subject to control in Russian Federation

Pharmacological properties
It is an agonist of opioid receptors (mu-, kappa-, delta-). It activates the endogenous antinociceptive system and thus disrupts the interneuronal transmission of pain impulses at various levels of the central nervous system, and also changes the emotional color of pain, affecting the higher parts of the brain.

Pharmacodynamics
Morphine increases the threshold of pain sensitivity with stimuli of different modality, inhibits conditioned reflexes, has euphorizing and moderate hypnotic effects, increases the tone of the vagus nerve center, inhibits the vomiting center, can stimulate the chemoreceptors of the triggering zone of the vomiting center, inhibits the respiratory center, causes pupil constriction due to the activation of the center of the oculomotor nerve, increases the tone of the bronchi and smooth muscle sphincters of internal organs (intestines, biliary tract, bladder), enhances the contractile activity of myometrium, weakens intestinal motility, inhibits the secretory activity of the glands of the gastrointestinal tract. It slightly reduces the basal metabolism and body temperature, stimulates the release of antidiuretic hormone. It causes the expansion of peripheral blood vessels and the release of histamine, which can lead to a decrease in blood pressure, redness of the skin, increased sweating, reddening of the albumin of the eyes. When administered subcutaneously, the effect develops in 10-20 minutes and lasts for 3-5 hours.
It causes addiction and drug (opioid) dependence (morphinism).

Pharmacokinetics
The volume of distribution is 4 l / kg. 30-35% of the drug binds to blood plasma proteins. C max 50-90 min. The half-life is 2-4 hours.
About 10% of the parenterally administered drug is excreted in the urine within 24 hours unchanged, 80% - in the form of glucuronide metabolites, the rest is excreted in the bile and excreted by the intestines. Penetrates the blood-brain barrier and placental barrier and is found in breast milk.

Indications for use
Morphine is used as an analgesic for severe pain syndrome of traumatic origin, in the preoperative, operational and postoperative periods, with myocardial infarction, severe attacks of angina pectoris, pain in malignant tumors and other conditions accompanied by severe pain.

Contraindications
Hypersensitivity to opiates.
Conditions accompanied by respiratory depression or severe depression of the central nervous system. Convulsive states. Increased intracranial pressure. Head trauma. Acute alcoholic conditions and alcoholic psychosis. Bronchial asthma... Paralytic intestinal obstruction. Heart failure due to chronic lung disease. Cardiac arrhythmias. Acute surgical diseases of the abdominal organs prior to diagnosis. Conditions after surgical interventions on the biliary tract. Morphine should not be used during treatment with monoamine oxidase (MAO) inhibitors and for another 14 days after their cancellation.

Use with caution
Chronic obstructive pulmonary disease, drug dependence (including a history), alcoholism, suicidal tendencies, emotional lability, cholelithiasis, surgical interventions on the gastrointestinal tract, urinary system, hepatic or renal failure, hypothyroidism, severe inflammatory bowel disease, prostatic hyperplasia, urethral strictures, epileptic syndrome.
General serious condition of the patient, elderly age, childhood.

Application during pregnancy and lactation
During pregnancy, childbirth and period breastfeeding the use of morphine is permissible only for health reasons (the development of drug dependence in the fetus and newborn is possible).

Method of administration and dosage
Morphine is administered subcutaneously. Doses are selected individually, depending on the age and condition of the patient.
Adults: the usual doses for adults under the skin are 1 ml of a 10 mg / ml solution. The analgesic effect develops in 10-15 minutes, reaches a maximum in 1-2 hours and lasts for 8-12 or more hours
Higher doses for adults under the skin: single 0.02 g, daily -0.05 g.
Children from birth to 2 years old
Subcutaneously 100 - 200 mcg / kg body weight (0.1 - 0.2 mg / kg), if necessary, every 4-6 hours, so that the total dose does not exceed 15 mg.
Children over 2 years old
Subcutaneously 100 - 200 μg / kg body weight (0.1 - 0.2 mg / kg), if necessary, every 4-6 hours, so that the total dose does not exceed 1.5 mg / kg body weight

Side effect
From the digestive system: more often - nausea and vomiting (more often at the beginning of therapy), constipation; less often - dry mouth, anorexia, biliary tract spasm, cholestasis (in the main bile duct), gastralgia, stomach cramps; rarely - hepatotoxicity (dark urine, pale stools, hysteria of the sclera and skin), with severe inflammatory bowel diseases - intestinal atony, paralytic intestinal obstruction, toxic megacolon (constipation, flatulence, nausea, stomach cramps, vomiting).
On the part of the cardiovascular system: more often - a decrease in blood pressure, tachycardia, less often - bradycardia, the frequency is unknown - an increase in blood pressure.
From the respiratory system: more often - oppression of the respiratory center, less often - bronchospasm, atelectasis.
From the nervous system: more often, dizziness, fainting, drowsiness, unusual tiredness, general weakness; less common - headache, tremors, involuntary muscle twitching, discoordination muscle movements, paresthesia, nervousness, depression, confusion (hallucinations, depersonalization), increased intracranial pressure with the likelihood of subsequent cerebrovascular accident, insomnia; rarely - restless sleep, depression of the central nervous system, against the background of high doses - muscle rigidity (especially respiratory), in children - paradoxical agitation, anxiety; frequency unknown - convulsions, nightmares, sedation or stimulation (especially in elderly patients), delirium, decreased ability to concentrate.
From the genitourinary system: less often - decreased urine output, spasm of the ureters (difficulty and pain during urination, frequent urge to urinate), decreased libido, decreased potency; the frequency is unknown - spasm of the sphincter of the bladder, impaired outflow of urine or aggravation of this condition with prostatic hyperplasia and stenosis of the urethra.
Allergic reactions: more often - wheezing, facial flushing, facial rash; less often - skin rash, urticaria, pruritus, facial edema, tracheal edema, laryngospasm, chills.
Local reactions: hyperemia, edema, burning at the injection site.
Others: more often - increased sweating, dysphonia; less often - impaired clarity of visual perception (including diplopia), miosis, nystagmus, an imaginary feeling of well-being, a feeling of discomfort; frequency unknown - ringing in the ears, drug dependence, tolerance, withdrawal syndrome (muscle pain, diarrhea, tachycardia, mydriasis, hyperthermia, rhinitis, sneezing, sweating, yawning, aiorexia, nausea, vomiting, nervousness, fatigue, irritability, tremor, stomach cramps, general weakness, hypoxia, muscle contractions, headache, increased blood pressure and other autonomic symptoms).
With repeated use of morphine for 1-2 weeks (sometimes within 2-3 days, it is possible to develop addiction (weakening of the analgesic effect) and opioid drug dependence.

Overdose
In case of poisoning or overdose, a stupor or coma develops, hypothermia, a decrease in blood pressure, and respiratory depression is observed. A characteristic feature is a pronounced constriction of the pupils (with significant hypoxia, the pupils can be dilated).
First aid for poisoning - maintaining adequate pulmonary ventilation Intravenous administration of the specific opioid antagonist naloxone in a dose of 0.4 to 2 mg quickly restores breathing. If there is no effect after 2-3 minutes, the introduction of naloxone is repeated. The starting dose of naloxone for children is 0.01 mg / kg. It is possible to use nalorphine: 5-10 mg intramuscularly or intravenously every 15 minutes for a total dose of 40 mg. Consideration should be given to the possibility of withdrawal from the administration of naloxone and nalorphine to morphine-dependent patients - in such cases, the dose of antagonists should be increased gradually.

Interaction
Strengthens the effect of hypnotics, sedatives, local anesthetic drugs, drugs for general anesthesia and anxiolytics.
Ethanol, muscle relaxants and drugs that depress the central system, increase the deprimating effect and respiratory depression.
Buprenorphine (including prior therapy) reduces the effect of other opioid analgesics; against the background of the use of high doses of agonists of mu-opioid receptors reduces respiratory depression, and against the background of the use of low doses of agonists of mu- or kappa-opioid receptors - increases; accelerates the onset of withdrawal symptoms when you stop taking mu-opioid receptor agonists against the background of drug dependence, and when they are suddenly withdrawn, it partially reduces the severity of these symptoms. With the systematic use of barbiturates, especially phenobarbital, there is a possibility of a decrease in the severity of the analgesic effect of narcotic analgesics, stimulates the development of cross-tolerance.
When taken simultaneously with beta-blockers, an increase in the inhibitory effect on the central nervous system is possible, with dopamine - a decrease in the analgesic effect of morphine, with cimetidine - an increase in respiratory depression, with other opioid analgesics - depression of the central nervous system, respiration, and a decrease in blood pressure.
Chlorpromazine enhances the miotic, sedative and analgesic effects of morphine.
Derivatives of phenothiazine and barbiturates enhance the hypotensive effect and increase the risk of respiratory depression.
Naloxone reduces the effect of opioid analgesics, as well as respiratory depression and central nervous system depression caused by them; large doses may be required to neutralize the effects of butorphanol, nalbuphine and pentazocine, which have been prescribed to eliminate the unwanted effects of other opioids; can accelerate the onset of withdrawal symptoms in the presence of drug addiction.
Naltrexone accelerates the onset of withdrawal symptoms against the background of drug addiction (symptoms may appear within 5 minutes after drug administration, continue for 48 hours, are characterized by persistence and difficulty in eliminating them); reduces the effect of opioid analgesics (analgesic, antidiarrheal, anti-cough); does not affect symptoms due to histamine reaction. Nalorphine eliminates respiratory depression caused by morphine.
Strengthens the hypotensive effect of drugs that lower blood pressure (including ganglion blockers, diuretics).
Competitively inhibits the hepatic metabolism of zidovudine and reduces its clearance (the risk of their mutual intoxication increases).
Medicines with apticholinergic activity, antidiarrheal medicines (including loperachid) increase the risk of constipation up to intestinal obstruction, urinary retention and depression of the central nervous system. Reduces the effect of metoclopramide.

special instructions
Morphine is used with caution in elderly patients, with general exhaustion, with diseases of the liver and kidneys, and insufficiency of the adrenal cortex. Under close supervision and in reduced doses, morphine should be used against the background of the action of drugs acting on the central nervous system (drugs for anesthesia, sleeping pills, anxiolytics, antidepressants, antipsychotics, anti-histamines, other non-narcotic pain medications) in order to avoid excessive depression of the central nervous system and suppression of the activity of the respiratory center.
The drug should not be combined with narcotic analgesics from the group of partial agonists (buprenorphine) and agonists - antagonists (nalbuphine, butorphanol, tramadol) of opioid receptors because of the danger of weakening analgesia and the possibility of provoking withdrawal syndrome in patients with dependence on opioids. The analgesic effects and undesirable effects of opioid agonists (trimeperidine, fentanyl) in the therapeutic dose range are combined with the effects of morphine. During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions, and avoid the use of ethanol.
Do not use in situations where paralytic ileus may occur. If there is a threat of paralytic ileus, the use of morphine should be stopped immediately.
In patients with suspected cardiac surgery or other surgery with intense pain, the use of morphine should be discontinued 24 hours before surgery. If therapy is subsequently shown, then the dosage regimen is selected taking into account the severity of the operation.
Sometimes tolerance and dependence on the drug may occur. If nausea and vomiting occur, a combination with phenothiazine can be used. To reduce the side effects of morphine preparations on the intestines, laxatives should be used.
It should be borne in mind that children under 2 years of age are more sensitive to the effects of opioid analgesics and may have paradoxical reactions.

Release form
Solution for subcutaneous administration 10 mg / ml in syringe tubes of 1 ml (1 cm3) 20, 50 or 100 syringe tubes with instructions for use in a cardboard box.

Storage conditions
In a dark place at a temperature not exceeding 15 ° C. List II of the "List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation." Keep out of the reach of children.

Conditions of dispensing from pharmacies
Dispensed from pharmacies on prescription with the same restrictions as other narcotic analgesics.

Best before date
2 years. It is prohibited to use the drug later than the date indicated on the package.

Manufacturer
Federal State Unitary Enterprise "Moscow Endocrine Plant", 109052, Moscow, Novokhokhlovskaya st., 25.
Consumer claims should be sent to the manufacturer.