DRUG SUPPLIED DOSE COMMENTS
MORPHINE (Paeds)


Mechanism of action:

Opioid analgesic


Ref: 32, 44, 582, 583


Last update: 2022-07-07
injection:  10 mg/10mL, 2 mg/mL, 10 mg/mL, 15 mg/mL, 100 mg/4 mL.
100 mg/100 mL PCA bag

Immediate-release tab: 5 mg

oral solution: 1 mg/mL, 5 mg/mL
 
Standard concentrations for IV infusion:

200 mcg/mL (pts up to 6 kg)
400 mcg/mL (pts 6-30 kg)
1000 mcg/mL (pts > 30 kg)

sustained release capsule: 10 mg, 15 mg, 30 mg, 100 mg


 Continuous IV Infusion:
Infants < 3 months old:
5-20 mcg/kg/hr
[Note: patients outside critical care must be managed by Acute Pain Service]

Children > 3 months old:
5-40 mcg/kg/hr usual range.  Higher doses may be required, especially in opioid-tolerant patients, palliative care or end of life symptom management

Intermittent Dosing:  
Infants < 6 months:
0.08 to 0.1 mg/kg/dose PO Q3-4H PRN
0.025 to 0.03 mg/kg/dose IV Q2-4H PRN

Children > 6 months:
Oral: 0.1 to 0.3 mg/kg/dose PO Q3-4H PRN (initial max 10 to 15 mg/dose)
IV/SC: 0.05 to 0.1 mg/kg/dose IV/SC Q2-4H PRN (Usual max: infants = 2 mg; children < 6 years = 4 mg; 7-12 years = 8 mg; >12 years = 10 mg)
(Usual max 0.2 mg/kg/dose)

Children > 50 kg:
Oral: 15-20 mg/dose PO Q3-4H PRN
IV/SC: 2-5 mg/dose IV/SC Q2-4H PRN
Refer to "Postoperative Disposition Guidelines for infants" for continuous opioid infusions in infants on PHSA SHOP

Respiratory depression is a risk in non-ventilated patients and infants ≤ 3 months are more susceptible.
 
Continuous IV infusion for overweight patients should be managed by the Acute Pain Service, and dosing weight should be determined after consulting the "Drug Dosing Weight Normograph"

Begin with lowest dose and titrate as required to achieve adequate pain to minimize opioid related adverse effects.

Use palliative care module in the Alaris pump only under supervision of APS, complex pain or palliative care services.

Antidote for opioid overdose is naloxone.

Dose reductions are required in renal and hepatic impairment.

See Opioid Administration Guidelines in Supplementary and References (white pages of print copy).  

Use extreme caution when converting from one opioid to another. Consult with APS/Palliative Care when converting opioids. Cross-tolerance at the opioid receptor may not occur and equianalgesic opioid dosing tables may overestimate opioid requirements.

Higher doses may be required for opioid tolerant patients.

Sustained release capsules are NOT suitable for PRN dosing. Daily morphine requirements should be established using immediate release formulations before converting to long acting formulations.  Sustained release formulations are usually dosed Q8-12H.

Sustained release tablets should generally be swallowed whole.  Consult individual product monograph prior to manipulating the formulation.





Standard Prescription:

morphine __mg IV/SC Q__H PRN

morphine (sustained release) __mg PO Q__H

morphine__mcg/kg/hr continuous IV infusion

Use pre-printed order forms for morphine infusions