Pain relief with Morphine: instructions for use

Content:

1. Mechanism of action of morphine
2. How long does it last?
3. Use of high doses
4. Morphine dosages
5. When is morphine strictly contraindicated?
6. Side effects that occur in morphine addicts
7. Effect of morphine as a drug

Morphine is a strong narcotic drug.
Doctors use it as a pain reliever if pain symptoms cannot be relieved with safer analgesics. Thus, it is prescribed for serious traumatic injuries, oncology, traumatic shock, and after complex surgical interventions. If the doctor has a choice, he will always offer the patient a safer alternative. This is due to the side effects of morphine on the central nervous system, respiration, and gastrointestinal tract.

Signs and consequences of use

With long-term use, the alkaloid causes sleep disturbances, memory disorders, and depression. It destroys the brain and central nervous system, changes the personality and leads to its degradation. When addicted, people go to great lengths to get morphine—either buy it or obtain it through criminal means. As an opiate drug, morphine can be detected in the body using antagonist substances. Naloxone or a similar drug is given by injection, followed by severe withdrawal symptoms.

Addiction can be identified by the appearance of the patient, whose body is destroyed by the drug. A morphine addict is a person with dry, sallow skin, constricted pupils, decayed teeth, and poor condition of hair and nails. He often experiences fever followed by chills, psychomotor agitation, and faints. In drug addicts, libido decreases, digestion is disrupted, and the heart beats quickly.

Mechanism of action of morphine

The drug is able to interact with opioid-sensitive receptors. As a result, various intracellular biochemical processes are activated. The effect of morphine on the human body can be described as follows:

• the excitability of pain receptors decreases;
• the work of the central nervous system is inhibited;
• conditioned reflexes are inhibited;
• the excitability of the cough center decreases;
• the tone of the smooth muscles of internal organs increases;
• the production of hydrochloric acid in the stomach is minimized;
• sphincters located in the gastrointestinal tract and biliary tract, bladder, become tense;
• body temperature constantly “jumps” and sometimes reaches critical levels;
• The production of the antidiuretic hormone vasopressin increases.

The drug morphine also affects the respiratory center. The combination of all these effects is of great importance in the treatment of various diseases. But, if a person starts taking the drug to get high, he faces life-threatening complications.

Drug interactions

• beta-blockers: possible increase in inhibitory effect on the central nervous system;
• narcotic analgesics included in the group of partial agonists (buprenorphine), opioid receptor agonists-antagonists (butorphanol, nalbuphine, tramadol), dopamine: there is a risk of decreased analgesia and withdrawal syndrome in people addicted to opioids; combination not recommended;
• barbiturate and phenothiazine derivatives: the hypotensive effect is enhanced and the risk of respiratory depression is aggravated;
• chlorpromazine: an increase in the sedative, miotic and analgesic effects of morphine is recorded;
• other opioid analgesics: respiratory depression and central nervous system function are observed, as well as a decrease in blood pressure;
• zidovudine: suppression of the hepatic metabolism of this substance and a decrease in its clearance are noted, the danger of mutual intoxication of the drugs increases;
• naltrexone: the occurrence of withdrawal symptoms is observed against the background of drug addiction (they can be observed as early as 5 minutes after administration of the drug and continue for 48 hours, they are distinguished by the persistence and complexity of the elimination process);
• cimetidine: increased respiratory depression;
• mexiletine: impaired absorption of this substance may occur;
• drugs that lower blood pressure, including diuretics, ganglion blockers: an increase in the hypotensive effect of these drugs is recorded;
• drugs exhibiting anticholinesterase activity, antidiarrheals (including loperamide): the risk of depression of central nervous system function, urinary retention and constipation, including intestinal obstruction, may be aggravated;
• metoclopramide: the effect of this substance is reduced;
• aminophylline, sodium salts of barbiturates and phenytoin; acyclovir sodium, fluorouracil, doxorubicin, sodium heparin, furosemide, tetracyclines, promethazine hydrochloride (Diprazine, Pipolfen): the incompatibility of these drugs with morphine has been established;
• bromides, iodides, tannin and tannins, oxidizing agents, alkalis and substances with an alkaline reaction: the use of morphine hydrochloride is incompatible with these drugs, since it is destroyed in an alkaline environment (during the reaction with oxidizing agents, a more toxic metabolite of morphine is formed - dioxymorphine, and when combined with alkalis, the morphine base precipitates).

Use of high doses

If a large dose of morphine is administered, severe drowsiness will occur. Therefore, the drug is prescribed to people who cannot sleep normally due to severe pain. High dosages also contribute to:

• inhibition of conditioned reflexes;
• blocking the cough and respiratory centers;
• the occurrence of bradycardia;
• severe constriction of the pupils;
• overexcitation of cranial nerves.

Taking high doses of the drug results in bronze spasm and disturbances in the functioning of the gastrointestinal tract. There is a weakening of intestinal peristalsis, and in the stomach, peristalsis, on the contrary, increases. Thanks to this, the lumen of the gastrointestinal tract is quickly cleared (doctors use this effect if they need to conduct an examination of the upper gastrointestinal tract).

Compound

Morphine intended for injections and the medicine in tablets have different compositions. The active ingredient for each dosage form is also different.

Pills

• Active ingredient: Morphine sulfate pentahydrate (amount of ADV - depending on dosage)
• Aqueous dispersion of ethylcellulose
• Macrogol
• Sucrose
• Corn starch
• Dibutyl sebacate
• Talc
• Gelatin (body)

Solution

The composition of 1 ml of Morphine solution includes the active ingredient and auxiliary components:

• Morphine hydrochloride – 8.56 mg
• Disodium salt of ethylenediaminetetraacetic acid
• Hydrochloric acid solution
• Glycerol
• Water for injections

When is morphine strictly contraindicated?

There is a group of patients who cannot be given a narcotic even if the pain is unbearable. Among the contraindications to the use of the medicine:

• allergy to it;
• alcohol, drug intoxication;
• severe disturbances in the activity of the central nervous system;
• acute intestinal obstruction;
• bleeding disorders;
• severe infection;
• mental disorders.

Patients with:

• gallstones;
• recent neck/head injury;
• edema syndrome;
• renal/liver failure;
• inflammation of the intestines;
• prostate adenoma;
• disruptions in the functioning of the thyroid gland.

The drug should be administered with extreme caution to patients who have recently undergone surgery on the stomach or intestines, pregnant and nursing mothers, and during the rehabilitation period after removal of the gallbladder.

Needless to say, if a drug addict with any of the above diagnoses starts using morphine, his life will be short-lived. It is unacceptable to take a drug to relax or get rid of withdrawal symptoms. This is a road to nowhere. If you become dependent on a drug, you should get qualified drug treatment help as soon as possible.

History of morphine

Morphine has been used by humanity for many centuries as an analgesic and sleeping pill. It received its name in honor of the ancient Greek god of dreams Morpheus, the younger brother of the god of death. How to obtain morphine, what it was, was already known in the ancient world, but it was first isolated in the laboratory only at the beginning of the 19th century. The German pharmacologist F. Sertuner gave the substance a name and described its properties. The first purified alkaloid became widespread after the invention of the injection needle and became widely used in operations.

Numerous wars (American Civil, Franco-Prussian and others) spread the dangerous substance and caused addiction among soldiers and officers. Due to the active use of the drug to reduce pain in the wounded, morphine began to be talked about as the cause of “army disease.” Having studied it, at the end of the 19th century, doctors at an international conference announced that a new disease had appeared - drug addiction. The world community learned that morphine is a drug, but in controlled doses it was used for a long time as a drug for insomnia, pain, neuralgia and as a treatment for alcoholism. Today in medicine the substance is treated with much more caution.

Side effects that occur in morphine addicts

The gastrointestinal tract is most affected by the drug. But this does not mean that any of the organs or systems have natural protection from the drug - it is toxic to everything. After its administration, the following may occur:

• nausea, vomiting, abdominal pain;
• symptoms of bile stagnation, discomfort in the right hypochondrium;
• spasms of the stomach, epigastrium;
• the skin acquires a painful icteric tint;
• paralytic ileus;
• enlarged colon;
• dizziness;
• headache;
• fainting;
• tremor of the limbs;
• muscle spasms;
• depression;
• impaired coordination of movements;
• disturbance of consciousness;
• surges in intracranial pressure;
• stroke;
• seizures;
• dilated pupils;
• decreased vision;
• involuntary eye movements.

From the cardiovascular system, tachycardia and decreased blood pressure are possible. Morphine often causes severe bronchospasm and even lung atelectasis. They inhibit diuresis, spasm the ureters and urethra. As a result, an imperative and painful urge to urinate occurs. Addicts often experience impotence and erectile dysfunction.

The occurrence of allergies cannot be ruled out. Then the skin becomes covered with a rash, urticaria occurs, and Quincke's edema or bronchospasm develops.

Overdose

Symptoms of acute and chronic overdose of Morphine hydrochloride may include: miosis (in case of significant hypoxia, dilation of the pupils is possible), hypothermia, dry oral mucosa, severe weakness, drowsiness, dizziness, nervousness, anxiety, cold sticky sweat, decreased blood pressure, confusion, bradycardia, slow labored breathing, muscle rigidity, intracranial hypertension (up to cerebrovascular accident), convulsions, delirious psychosis, hallucinations, in severe cases - loss of consciousness, coma, respiratory arrest.

First aid in case of overdose is to take measures to maintain cardiac activity and adequate pulmonary ventilation. To quickly restore breathing, a specific antagonist of opioid analgesics is prescribed intravenously - naloxone (Narcan) at a dose of 0.4-2 mg; if there is no effect after 2-3 minutes, the drug can be re-administered, but not more than 10 mg per day. For children, the starting dose of naloxone is 0.01 mg/kg.

It is necessary to take into account the possible risk of developing withdrawal syndrome when using naloxone and nalorphine in patients with morphine addiction; in such cases, it is recommended to increase the dose of antagonists gradually.

Effect of morphine as a drug

As practice shows, most often people who become addicted to morphine are those who have been forced to treat with it for some time. Subsequently, they do not find the strength to stop using the dangerous medicine. Continue to enter it to:

• get a pronounced euphoric effect;
• relax;
• relieve tension;
• get rid of drug withdrawal.

Typically, drug addicts use drugs in doses exceeding therapeutic ones. This is due to the fact that addicts gradually develop tolerance to the medicine. Then they are forced to give themselves injections more often than once every six hours. In this case, a single dose can reach up to 100 or even 200 mg. This often leads to overdose and subsequent death.

Often drug addicts try to switch from morphine to tramadol. The latter is easier to get. But this does not make their mental and physical condition any better. There is no point in experimenting with more accessible narcotic drugs. If you can’t quit on your own (and this almost always happens), you need to immediately go to a drug treatment clinic. This is the only way to defeat a deadly disease - drug addiction.

Morphine hydrochloride, instructions for use: method and dosage

Morphine hydrochloride solution in ampoules is administered subcutaneously, intravenously, intramuscularly, or epidurally (depending on the manufacturer). Doses of the drug are determined individually, taking into account the condition and age of the patient.

Dosage regimen for adults

Adults are prescribed subcutaneously, as a rule, 1 ml of solution, epidurally - 0.2–0.5 ml of the drug diluted in an isotonic solution of sodium chloride in a dose of 10 ml. The analgesic effect develops 10–15 minutes after administration and reaches a maximum after 1–2 hours. For subcutaneous injections for adults, the highest single dose is 10 mg, the daily dose is 50 mg.

In the presence of edema, subcutaneous administration of Morphine hydrochloride is not recommended. If the patient is prescribed intravenous administration of the drug, 1 ml of the drug must be diluted in 10 ml of 0.9% sodium chloride solution. The resulting solution is administered intravenously slowly, in small increments at 5-minute intervals of 3–5 ml until pain is completely relieved.

Dosage regimen for children

For children, Morphine hydrochloride is administered parenterally, sometimes in combination with oral forms of morphine in doses ranging from 0.05 to 0.2 mg/kg per dose.

Subcutaneous administration of the drug is recommended in a dose of 0.1–0.2 mg/kg, if necessary, every 4–6 hours, but the total daily dose for children from birth to 2 years should not exceed 15 mg, for children over 2 years – 1.5 mg/kg.

IV Morphine hydrochloride is administered very slowly: for children under 2 years old - 0.05–0.1 mg/kg, during constant IV infusion at a dose of 0.01–0.015 mg/kg/h; children over 2 years old - 0.05–0.2 mg/kg, with constant infusion – 0.02–0.05 mg/kg/hour.

For premedication purposes, Morphine hydrochloride should be administered intramuscularly at 0.05–0.1 mg/kg. As a component of general anesthesia, 0.1–0.5 mg/kg is prescribed intravenously. The total total dose for children from 0 to 2 years old should be no more than 15 mg, over 2 years old - no more than 50 mg.

For epidural administration, it is recommended to use Morphine hydrochloride in doses of 0.05–0.1 mg/kg, previously diluted in an isotonic sodium chloride solution in a dose of 2–4 ml – for children under 2 years old, in a dose of 4–10 ml – over 2 years old . Anesthesia is observed after 15–20 minutes and reaches a maximum after 60 minutes, the duration of action is 12 hours or more.

Literature:

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