Morphine hydrochloride: Instructions for use: Description of the drug: Price on EUROLAB

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Manufacturers: Macfarlan Smith Limited

Active ingredients

Morphine

Disease class

Unstable angina
Fever of unknown origin
Acute pain
Constant, unrelieved pain
Trauma of unspecified location
Surgical practice

Clinical and pharmacological group

Not indicated. See instructions

Pharmacological action

Analgesic (narcotic)

Pharmacological group

Opioid narcotic analgesics

Substance-powder Morphine hydrochloride (Morphine hydrochloride)

Instructions for medical use of the drug

Description of pharmacological action

Stimulates mu, delta and kappa subtypes of opioid receptors. Inhibits the interneuronal transmission of pain impulses in the central part of the afferent pathway, reduces the emotional assessment of pain, the reaction to it, causes euphoria (mood improves, there is a feeling of mental comfort, complacency and bright prospects, regardless of the real state of affairs), which contributes to the formation of dependence (mental and physical). Reduces the excitability of the thermoregulation center, stimulates the release of vasopressin. It has virtually no effect on vascular tone. In high doses, it exhibits sedative activity, depresses the respiratory, cough and, as a rule, vomiting centers, stimulates the centers of the oculomotor (miosis) and vagus (bradycardia) nerves. Increases the tone of the smooth muscles of the gastrointestinal sphincters with a simultaneous decrease in peristalsis (locking effect). May stimulate the chemoreceptors of the vomiting center trigger zone and cause nausea and vomiting.

Indications for use

Severe pain syndrome (with myocardial infarction, unstable angina, trauma, in the postoperative period, with cancer), as an additional drug for premedication, epidural and spinal anesthesia.

Release form

powder substance; plastic bag (bag) of 1,2,3,5,10,20 and 25 kg, polypropylene container 1;

Pharmacodynamics

Pharmacokinetics

It is quickly absorbed into the blood by any route of administration (orally, subcutaneously and intramuscularly). Easily passes barriers, incl. BBB, placental (can cause depression of the respiratory center in the fetus and therefore is not used for pain relief during labor). Metabolized, forming mainly glucuronides and sulfates. Excreted by the kidneys. Small amounts are secreted by all exocrine glands. The analgesic effect develops 5–15 minutes after subcutaneous and intramuscular administration, after oral administration - after 20–30 minutes and usually lasts 4–5 hours.

Use during pregnancy

During pregnancy and during breastfeeding, use is permissible only for health reasons (respiratory depression and the development of drug dependence in the fetus and newborn are possible).

Other special occasions at reception

Restrictions on use: general severe exhaustion, attack of bronchial asthma, COPD, arrhythmia, convulsions, drug dependence (including history), alcoholism, suicidal tendencies, emotional lability, surgical interventions on the gastrointestinal tract, urinary system; hypothyroidism, severe inflammatory bowel disease, prostatic hyperplasia, urethral stenosis, liver and/or renal failure, insufficiency of the adrenal cortex, old age (the metabolism and excretion of morphine slows down, its level in the blood increases).

Contraindications for use

Hypersensitivity, depression of the respiratory center, severe depression of the central nervous system, abdominal pain of unknown etiology, brain injury, intracranial hypertension, status epilepticus, acute alcohol intoxication, delirious psychosis, pulmonary heart failure due to chronic lung diseases, arrhythmia, paralytic ileus, post-mortem condition surgical intervention on the biliary tract, simultaneous treatment with MAO inhibitors, pregnancy, lactation, children under 2 years of age; with epidural and spinal analgesia (additionally): blood coagulation disorders (including during anticoagulant therapy), infections (risk of infection entering the central nervous system).

Side effects

From the nervous system and sensory organs: dizziness, headache, asthenia, anxiety, irritability, insomnia, nightmares, confusion, hallucinations, delirium, increased intracranial pressure, paresthesia, involuntary muscle twitching, convulsions, incoordination of movements, blurred vision, nystagmus , diplopia, miosis, ringing in the ears, changes in taste; against the background of large doses - muscle rigidity (especially respiratory); in children - paradoxical arousal; physical and mental dependence (after 1–2 weeks of regular use), withdrawal syndrome. From the cardiovascular system and blood (hematopoiesis, hemostasis): tachycardia/bradycardia, palpitations, decreased/increased blood pressure, fainting. From the respiratory system: depression of the respiratory center, bronchospasm, atelectasis. From the gastrointestinal tract: nausea, vomiting, constipation/diarrhea, dry mouth, anorexia, gastralgia, spasm of the biliary tract, cholestasis; in severe inflammatory bowel diseases - intestinal atony, paralytic ileus, toxic megacolon (constipation, flatulence, nausea, stomach cramps, vomiting). From the genitourinary system: decreased diuresis, spasm of the ureters (difficulty and pain when urinating, frequent urge to urinate), spasm of the bladder sphincter, impaired outflow of urine or aggravation of this condition with prostatic hyperplasia and stenosis of the urethra, decreased libido and/or potency . Allergic reactions: wheezing, facial flushing, facial swelling, tracheal swelling, laryngospasm, chills, itching, rash, urticaria. Other: increased sweating, dysphonia, weight loss, dehydration, pain in the extremities; local reactions - hyperemia, swelling, burning at the injection site.

Directions for use and doses

SC, IM or IV. The dosage regimen is individual, doses depend on the indications, route of administration, and patient's condition. The highest daily dose for adults is 50 mg (except for incurable cancer patients, in whom it can reach 1 g/day). Frequency of administration: every 12 hours.

Overdose

Symptoms of acute and chronic overdose: cold clammy sweat, confusion, dizziness, drowsiness, decreased blood pressure, nervousness, fatigue, miosis, bradycardia, severe weakness, slow difficulty breathing, hypothermia, anxiety, dry oral mucosa, delirious psychosis, intracranial hypertension (up to cerebrovascular accident), hallucinations, muscle rigidity, convulsions, in severe cases - loss of consciousness, respiratory arrest, coma. Treatment: resuscitation measures, intravenous administration of a specific antagonist of opioid analgesics - naloxone.

Interactions with other drugs

Extends and enhances the effect of drugs that depress the activity of the central nervous system, incl. sleeping pills, sedatives, drugs for general anesthesia, anxiolytics, neuroleptics and local anesthetics. Drugs that depress the central nervous system, incl. ethanol, enhance the depressive effect and respiratory depression (muscle relaxants also act). With systematic use of barbiturates, especially phenobarbital, there is a possibility of a decrease in the severity of the analgesic effect. Caution should be used simultaneously with MAO inhibitors due to possible overexcitation or inhibition with the occurrence of hyper- or hypotensive crises (initially, to assess the effect of interaction, the dose should be reduced to 1/4 of the recommended). When taken simultaneously with beta-blockers, it is possible to increase the inhibitory effect on the central nervous system, with dopamine - a decrease in the analgesic effect of morphine, with cimetidine - increased respiratory depression, with other opioid analgesics - increased depression of the central nervous system, respiration, hypotension. Chlorpromazine enhances the sedative and analgesic effects of morphine. Phenothiazine derivatives and barbiturates enhance the hypotensive effect and increase the risk of respiratory depression. Naloxone reduces the effect of opioid analgesics, as well as the respiratory and central nervous system depression they cause. Nalorphine reverses the 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 (increases the risk of mutual intoxication). Drugs with anticholinergic activity, antidiarrheal drugs (including loperamide) increase the risk of constipation, including intestinal obstruction, urinary retention and central nervous system depression. Reduces the effect of metoclopramide. Morphine may increase the anticoagulant activity of coumarin and other anticoagulants.

Precautions for use

Morphine should not be used in situations where paralytic ileus may occur. If there is a risk of paralytic ileus, the use of morphine should be discontinued immediately. In patients undergoing cardiac surgery or other surgery with intense pain, the use of morphine should be discontinued 24 hours before surgery. If therapy is subsequently indicated, the dosage regimen is selected taking into account the severity of the operation. If nausea and vomiting occur, a combination with a phenothiazine can be used. During the treatment period, 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. The simultaneous use of other drugs acting on the central nervous system (antihistamines, hypnotics, psychotropic drugs, other painkillers) is allowed only with the permission and under the supervision of a physician. It should be kept in mind that children under 2 years of age are more sensitive to the effects of opioid analgesics and may experience paradoxical reactions.

Storage conditions

In a place protected from light, at a temperature not exceeding 25 °C.

Best before date

36 months

ATX classification:

N Nervous system

N02 Analgesics

N02A Opioids

N02AA Opium alkaloids natural

N02AA01 Morphine

Content:

Mechanism of action of morphine
How long does it last?
Use of high doses
Morphine dosages
When is morphine strictly contraindicated?
Side effects that occur in morphine addicts
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.

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** The Drug Directory is intended for informational purposes only. For more complete information, please refer to the manufacturer's instructions. Do not self-medicate; Before you start using Morphine hydrochloride, you should consult your doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal. Any information on the site does not replace medical advice and cannot serve as a guarantee of the positive effect of the drug.

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** Attention! The information presented in this medication guide is intended for medical professionals and should not be used as a basis for self-medication. The description of the drug Morphine hydrochloride is provided for informational purposes and is not intended for prescribing treatment without the participation of a doctor. Patients need to consult a specialist!

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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).

How addiction is formed

Opiate drugs cause the most persistent addiction, and from the very first doses. The basis for the formation of such persistent addiction is that the body gets used to the flow of exogenous opiates and stops producing its own. And they are needed to reduce pain and are produced in small quantities constantly, even at rest. If such mediators did not exist, then a person would constantly live with a feeling of pain.

The main stages of morphine addiction include:

drug entry into the body;
binding to opioid receptors;
depletion of opioid receptors;
the appearance of resistance of opiate receptors to opiates;
the need to increase the amount of drug taken;
the body’s inability to produce its own opiates and their analogues;
the onset of physical dependence with mental disorders;
the emergence of psychological stigma for morphine addicts;
changes in behavioral instincts and constant search for a new dose of the drug.

Physical dependence is the depletion of substances that are able to bind to opiate receptors in the body. Therefore, a person needs a constant supply of these substances from the external environment.

Without the supply of morphine or its analogues, withdrawal begins to develop, which is very difficult to survive on your own.

The rate of addiction formation is directly related to the frequency of drug use and the single dose. Metabolic rate and individual characteristics of opiate receptors are less significant.

Treatment in hospital

Pharmacological support is always used in the hospital. Otherwise, it is impossible to make rehabilitation reliable and safe. In addition, psychological work must be carried out with each patient.

During the first period of up to 14 days, patients undergo cleansing of the body from morphine metabolites. They are prescribed an infusion, tests are carried out, and treatment for pain and dyspeptic syndromes is prescribed.

During withdrawal, the patient is placed in an artificial coma. At this time, it is fed with infusion therapy. All this allows you to survive withdrawal without pain or harm to the body.

Every day, patients can come to group classes or, if desired, to individual ones. Such trainings make it possible to restore the social significance of the patient. This way you can show his importance to people from the group, show that he is not the only one in the world, that everyone makes mistakes, but is ready to correct them.

According to scientific reports, the study of religion or rehabilitation methods with a religious bias are more likely to produce positive results.

The confessional (with a religious bias) approach has proven itself better than similar methods, but without a religious component.
Taken from the dissertation: “Resocialization of drug addicts: socio-psychological aspects” by Kutyanova I.P.

One of the ways to distract the patient from the desire to use “dope” is a constant change of activity. Therefore, occupational therapy is recommended for drug addicts. This is a reason to train your willpower, communicate with other people, and improve your physical health.

Due to opiates, patients become exhausted and lose weight. In specialized rehabilitation centers for drug addicts, they create a special high-calorie menu that helps to gain weight. The most delicious and healthy food always lifts the mood and morale of people who want to quit drugs.

Literature:

Drugs: properties, action, pharmacokinetics, metabolism: textbook / N.V. Veselovskaya [etc.]. — 3rd ed., revised, corrected. and additional - Moscow: Narkonet, 2008. - 262 p.
Opium addiction and combating drug trafficking: Social, legal, medical. aspects / Solodun Yu.V., Lavdarenko L.N., Soktoev Z.B. ; Prosecutor General of Russia. Federation [and others]. - Irkutsk: Irkut Publishing House. legal Institute, 2003 (PE Plyukhin R.A.). — 133 p.
A manual on narcology for doctors and paramedics of primary medical care / A. A. Churkin, T. V. Klimenko. - Moscow ; Khanty-Mansiysk: Health and Society, 2006 (Cheboksary: IPK Chuvashia). — 173 p.

Coding

There is not a single case in evidence-based medicine where coding helps with drug addiction or any other addiction.

The body requires a new dose at the level of receptors and synapses. In such matters, psychology plays a secondary role. Therefore, coding is not efficient.

There are no described techniques or methods for coding drug addicts. Only long-term rehabilitation with psychological work to restore personality and self lead to long-term and stable remission.

How to recognize a drug addict

The main route of morphine use is parenteral (by injection). Morphine is administered intramuscularly and intravenously, and in the second case, injection marks can always be found on the drug addict’s body.

Often people try to hide the fact that they have an addiction. So they inject the drug into the veins in the legs or the groin.

One of the effects of morphine is itching. Morphin addicts constantly scratch their skin; scratch marks and sometimes even wounds are visible. This is due to the fact that the genesis of itching is not skin problems, but pathological impulses coming from the central nervous system.

Morphine addicts do not recognize social standards. They leave the family or constantly conflict with it. They stop going to work and constantly disappear somewhere. If an addicted person is a student, he begins to skip school for no apparent reason.

Such people spend a lot of money on drugs, lose weight, are constantly sleepy and lethargic. To obtain morphine, a person is capable of the most cynical deception. They often steal jewelry and household appliances from the house.

Opiate drugs completely disrupt behavioral instincts. A morphine addict has no interests or aspirations.

In order to know for sure whether a person is using opiates or not, tests need to be done. There are no other reliable ways to confirm or refute guesses.

How to quit on your own

Doing this is more difficult than it might seem. You need to quit immediately, and not postpone the event for any other time.

It is important to completely renounce connections with all people who take drugs (even if other drugs, not morphine). Replacing one substance with another will not restore mental health, nor will the risk of new opiate use decrease.

Then the person must be prepared to experience withdrawal. This is one of the most difficult tests that await a drug addict after quitting.

For long-term remission, you need to find a new area of activity that is not related to drugs. Constant distraction and communication with new people is the key to long-term abstinence.

Working with codependents

People who live with a drug addict or are members of his family, having any physical or mental connection, are called codependent.

Such people can be the mainstay of recovery even for an opioid addict. But if the connection is too strong, any conflict leads to a new breakdown.

Working with such people is an important part of rehabilitation. They need to be taught how to help a patient go into remission, and taught the rules of communication and behavior with addicted people.

Codependent people at first must seek a compromise, provide physical and mental support. Such care should continue until the patient regains his social consciousness and until the drugs fade into the background.

Correct prioritization leads to more stable remission and improved relationships in the patient’s family.

How long do drug addicts live?

On average, morphine addicts live from 5 to 8 years from the moment they begin regular use, provided they actively use the drug. First of all, death occurs due to “wear and tear” of internal organs (liver, kidneys). The functioning of the central nervous system is disrupted. The nervous system is not able to adequately innervate organs, and this leads to premature atrophy and a complete decrease in organ function.

Another cause of death for morphine addicts is drug overdose.

Morphine addicts die of natural causes very rarely. The cause of death may be injury during drug intoxication.

Injecting drugs through a needle can transmit hepatitis C, hepatitis B, and HIV/AIDS to a person. Constant suppression of the immune system leads to the development of tuberculosis, which progresses rapidly and often causes exhaustion and death.

Due to injections, purulent complications appear at the injection sites. Due to the irritating effect of morphine, inflammation of the veins appears, against which thrombophlebitis and thrombosis develop, followed by the development of pulmonary embolism.

Opiates are toxic drugs. Affects the heart and liver. The average life of a drug addict is only 5-8 years. Addiction and physical dependence develop at lightning speed.
Taken from the scientific article: “Toxic depression of hematopoiesis in an opium addict.” Author A.V. Kosterina.

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Detoxification in hospital

It is easier to do this in a hospital, since there you can carry out infusion therapy and monitor the level of microelements in the blood plasma. The main method of inpatient detoxification from morphine is a 5% glucose infusion. This allows you to speed up filtration in the kidneys and remove drug metabolites.

In the hospital, symptomatic therapy is often used in the event of withdrawal syndrome or disorders of the internal organs.

Even in a hospital, Naloxone or its analogues are not administered to speed up the release of morphine from the blood. Such drugs only relieve the main symptoms of an opiate overdose, but do not reduce the amount of drug in the body.

Morphine is the main alkaloid of opium; it is found in opium about 10%.

Morphine was named this way by mistake; in fact, it does not have the properties of morphine. In 1804, it was obtained from plant materials (it was the first pure plant alkaloid). After morphine was obtained, it was practically forgotten and was not used in medicine as a medicine, but in 1835 an injection needle was created, after which morphine began to be used in intravenous injections.

It was not until the middle of the last century that morphine was fully synthesized, during which it was concluded that it should not be put up for wide sale. Today, natural morphine costs much less than synthetic morphine.

Morphine is used in medicine to relieve pain, and not so long ago it was used to replace alcohol or opium in cases of addiction to these substances. Now they are being replaced by codeine.

What does morphine look like?

Morphine is obtained from the plant's milky white matter. When finished, it looks like white crystals in the shape of needles. If the drug is stored, it may change color slightly over time and become grayish or yellowish. Morphine crystals cannot be dissolved in alcohol and water; they do not combine with alkali.

How does morphine affect the body?

Rehabilitation

Treatment of opioid addiction is one of the most difficult problems in modern addiction medicine. The essence of the problem is that such patients require constant care and monitoring. It is necessary to work with codependent people and restore the social role of the patient.

In addition, “withdrawal” always occurs, which not every patient can survive without breakdowns.

Rehabilitation from morphine should always be comprehensive. There are no single methods that cure; only a combination of techniques and the patient’s desire.

The complex of treatment for morphine addiction includes the following measures:

detoxification of the patient using infusion;
elimination of symptoms of organ dysfunction;
managing the patient during withdrawal;
work with a psychologist and psychiatrist;
restoration of role in society;
training and psychological preparation of codependent people.

Every person who begins treatment and his relatives must understand that it is impossible to recover from addiction. A person will periodically have desires to use the drug again. The task of specialists is to make sure that these desires appear extremely rarely and that it is easier to overcome them.

For independent rehabilitation, strong motivation and a developed volitional sphere are required; otherwise, “getting off the needle” will not work.