Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/2935
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Duramorph (Injection, Solution)
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DURAMORPH is
intended for intravenous, epidural or intrathecal
administration.<br/>Intravenous
Administration:<br/>Dosage: The
initial dose of morphine should be 2 mg to 10 mg/70 kg
of body weight. No information is available regarding
the use of DURAMORPH in patients under the
age of 18.<br/>Epidural
Administration: DURAMORPH
SHOULD BE ADMINISTERED EPIDURALLY BY OR UNDER THE DIRECTION OF A
PHYSICIAN EXPERIENCED IN THE TECHNIQUE OF EPIDURAL
ADMINISTRATION AND WHO IS THOROUGHLY FAMILIAR WITH THE LABELING.
IT SHOULD BE ADMINISTERED ONLY IN SETTINGS WHERE ADEQUATE
PATIENT MONITORING IS POSSIBLE. RESUSCITATIVE EQUIPMENT AND A
SPECIFIC ANTAGONIST (NALOXONE INJECTION) SHOULD BE IMMEDIATELY
AVAILABLE FOR THE MANAGEMENT OF RESPIRATORY DEPRESSION AS WELL
AS COMPLICATIONS WHICH MIGHT RESULT FROM INADVERTENT INTRATHECAL
OR INTRAVASCULAR INJECTION. (NOTE: INTRATHECAL DOSAGE IS USUALLY
1/10 THAT OF EPIDURAL DOSAGE.) PATIENT MONITORING SHOULD BE CONTINUED FOR AT LEAST 24 HOURS AFTER
EACH DOSE, SINCE DELAYED RESPIRATORY DEPRESSION MAY
OCCUR. Proper placement of a needle or catheter in the epidural space should
be verified before DURAMORPH is injected. Acceptable
techniques for verifying proper placement include: a) aspiration
to check for absence of blood or cerebrospinal fluid, or b)
administration of 5 mL (3 mL in obstetric patients) of 1.5%
PRESERVATIVE-FREE Lidocaine and Epinephrine (1:200,000)
Injection and then observe the patient for lack of tachycardia
(this indicates that vascular injection has not been made) and lack of
sudden onset of segmental anesthesia (this indicates that
intrathecal injection has not been made).<br/>Epidural
Adult Dosage: Initial injection of 5 mg in the lumbar region may
provide satisfactory pain relief for up to 24 hours. If adequate pain relief is not achieved within one hour,
careful administration of incremental doses of 1 to 2 mg
at intervals sufficient to assess effectiveness may be given. No more than 10 mg/24 hr should be administered. Thoracic administration has been shown to dramatically
increase the incidence of early and late respiratory
depression even at doses of 1 to 2 mg. For
continuous infusion, an initial dose of 2 to 4 mg/24
hours is recommended. Further doses of 1 to 2 mg may be
given if pain relief is not achieved
initially.<br/>Epidural
Pediatric Use: No
information on use in pediatric patients is available.<br/>Intrathecal
Administration: DURAMORPH
SHOULD BE ADMINISTERED INTRATHECALLY BY OR UNDER THE DIRECTION
OF A PHYSICIAN EXPERIENCED IN THE TECHNIQUE OF INTRATHECAL
ADMINISTRATION AND WHO IS THOROUGHLY FAMILIAR WITH THE LABELING.
IT SHOULD BE ADMINISTERED ONLY IN SETTINGS WHERE ADEQUATE
PATIENT MONITORING IS POSSIBLE. RESUSCITATIVE EQUIPMENT AND A
SPECIFIC ANTAGONIST (NALOXONE INJECTION) SHOULD BE IMMEDIATELY
AVAILABLE FOR THE MANAGEMENT OF RESPIRATORY DEPRESSION AS WELL
AS COMPLICATIONS WHICH MIGHT RESULT FROM INADVERTENT
INTRAVASCULAR INJECTION. PATIENT
MONITORING SHOULD BE CONTINUED FOR AT LEAST 24 HOURS AFTER
EACH DOSE, SINCE DELAYED RESPIRATORY DEPRESSION MAY
OCCUR. RESPIRATORY DEPRESSION (BOTH EARLY AND LATE
ONSET) HAS OCCURRED MORE FREQUENTLY FOLLOWING INTRATHECAL
ADMINISTRATION THAN EPIDURAL ADMINISTRATION.<br/>Intrathecal
Adult Dosage: A
single injection of 0.2 to 1 mg may provide satisfactory
pain relief for up to 24 hours. (CAUTION: THIS IS ONLY
0.4 TO 2 ML OF THE 5 MG/10 ML AMPUL OR 0.2 TO 1 ML OF
THE 10 MG/10 ML AMPUL OF DURAMORPH). DO NOT INJECT
INTRATHECALLY MORE THAN 2 ML OF THE 5 MG/10 ML AMPUL OR
1 ML OF THE 10 MG/10 ML AMPUL. USE IN THE LUMBAR AREA ONLY IS RECOMMENDED. Repeated intrathecal injections of
DURAMORPH are not recommended. A constant intravenous infusion of naloxone, 0.6 mg/hr, for 24 hours after
intrathecal injection may be used to reduce the
incidence of potential side effects.<br/>Repeat
Dosage: If
pain recurs, alternative routes of administration should
be considered, since experience with repeated doses of morphine by the intrathecal route is
limited.<br/>Intrathecal
Pediatric Use: No
information on use in pediatric patients is available.
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| dailymed-instance:descripti... |
Morphine is the
most important alkaloid of opium and is a phenanthrene derivative. It is
available as the sulfate salt, having the following structural formula: 7,8-Didehydro-4,5-epoxy-17-methyl-(5��,6��)-morphinan-3,6-diol sulfate
(2:1) (salt), pentahydrate (CHNO)���HSO���5HO Molecular Weight is
758.83 Preservative-free
DURAMORPH (morphine sulfate injection, USP) is a sterile, nonpyrogenic,
isobaric solution of morphine sulfate, free of antioxidants,
preservatives or other potentially neurotoxic additives and is intended
for intravenous, epidural or intrathecal administration as a narcotic
analgesic. Each milliliter contains morphine sulfate 0.5 mg or 1 mg and
sodium chloride 9 mg in Water for Injection. pH range is 2.5���6.5. Each
10 mL DOSETTE ampul of DURAMORPH is intended for SINGLE USE ONLY.Discard any unused portion. DO
NOT HEAT-STERILIZE.
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Morphine produces a
wide spectrum of pharmacologic effects including analgesia, dysphoria,
euphoria, somnolence, respiratory depression, diminished gastrointestinal motility and physical dependence. Opiate analgesia
involves at least three anatomical areas of the central nervous system:
the periaqueductal-periventricular gray matter, the ventromedial medulla
and the spinal cord. A systematically administered opiate may produce
analgesia by acting at any, all or some combination of these distinct
regions. Morphine interacts predominantly with the��-receptor. The��-binding sites of opioids are very discretely distributed in the human
brain, with high densities of sites found in the posterior amygdala,
hypothalamus, thalamus, nucleus caudatus, putamen and certain cortical
areas. They are also found on the terminal axons of primary afferents
within laminae I and II (substantia gelatinosa) of the spinal cord and
in the spinal nucleus of the trigeminal nerve. Morphine has an
apparent volume of distribution ranging from 1.0 to 4.7 L/kg afterintravenous dosage. Protein binding is low, about 36%,
and muscle tissue binding is reported as 54%. A blood-brain barrier
exists, and when morphine is introduced outside of the CNS (e.g.,intravenously), plasma
concentrations of morphine remain higher than the corresponding CSF
morphine levels. Conversely, when morphine is injected into the intrathecal space, it diffuses out
into the systemic circulation slowly, accounting for the long duration
of action of morphine administered by this route. Morphine has a
total plasma clearance which ranges from 0.9 to 1.2 L/kg/h
(liters/kilogram/hour) in postoperative patients, but shows considerable
interindividual variation. The major pathway of clearance is hepatic
glucuronidation to morphine���3���glucuronide, which is pharmacologically
inactive. The major excretion path of the conjugate is through the
kidneys, with about 10% in the feces. Morphine is also eliminated by the kidneys, 2 to 12% being excreted unchanged in the urine. Terminal
half-life is commonly reported to vary from 1.5 to 4.5 hours, although
the longer half���lives were obtained when morphine levels were monitored
over protracted periods with very sensitive radioimmunoassay methods.
The accepted elimination half-life in normal subjects is 1.5 to 2 hours. ���Selective���blockade of pain sensation is possible by neuraxial application of
morphine. In addition, duration of analgesia may be much longer by this
route compared to systemic administration. However, CNS effects,
associated with systemic administration, are still seen. These include
respiratory depression, sedation, nausea and vomiting, pruritus and
urinary retention. In particular, both early and late respiratory
depression (up to 24 hours post dosing) have been reported following
neuraxial administration. Circulation of the spinal fluid may also
result in high concentrations of morphine reaching the brain
stem directly. The incidence of
unwanted CNS effects, including delayed respiratory depression,
associated with neuraxial application of morphine, is related to the
circulatory dynamics of the epidural venous plexus and the spinal fluid.
The lipid solubility and degree of ionization of morphine plays an
important part in both the onset and duration of analgesia and the CNS
effects. Morphine has a pK7.9, with an octanol/water
partition coefficient of 1.42 at pH 7.4. At this pH, the tertiary amino
group in each of the opioids is mostly ionized, making the molecule
water soluble. Morphine, with additional hydroxyl groups on the
molecule, is significantly more water soluble than any other opioid in
clinical use. Morphine, injected
into the epidural space, is
rapidly absorbed into the general circulation. Absorption is so rapid
that the plasma concentration-time profiles closely resemble those
obtained after intravenous or intramuscular administration. Peak plasma
concentrations averaging 33���40 ng/mL (range 5���62 ng/mL) are achieved
within 10 to 15 minutes after administration of 3 mg of morphine. Plasma
concentrations decline in a multiexponential fashion. The terminal half-life is reported to range from 39 to 249 minutes (mean of 90��34.3
min) and, though somewhat shorter, is similar in magnitude as values
reported after intravenous and intramuscular administration (1.5���4.5 h).
CSF concentrations of morphine, after epidural doses of 2 to 6 mg in
postoperative patients, have been reported to be 50 to 250 times higher
than corresponding plasma concentrations. The CSF levels of morphine
exceed those in plasma after only 15 minutes and are detectable for as
long as 20 hours after the injection of 2 mg of epidural morphine.
Approximately 4% of the dose injected epidurally reaches the CSF. This
corresponds to the relative minimum effective epidural and intrathecal
doses of 5 mg and 0.25 mg, respectively. The disposition of morphine in
the CSF follows a biphasic pattern, with an early half-life of 1.5 h and
a late phase half-life of about 6 h. Morphine crosses the dura slowly,
with an absorption half-life across the dura averaging 22 minutes.
Maximum CSF concentrations are seen 60���90 minutes after injection.
Minimum effective CSF concentrations for postoperative analgesia average
150 ng/mL (range<1���380 ng/mL). The intrathecal route of administration
circumvents meningeal diffusion barriers and, therefore, lower doses of
morphine produce comparable analgesia to that induced by the epidural
route. After intrathecal bolus injection of morphine, there is a rapid
initial distribution phase lasting 15���30 minutes and a half-life in the
CSF of 42���136 min (mean 90��16 min). Derived from limited data, it
appears that the disposition of morphine in the CSF, from 15 minutes
postintrathecal administration to the end of a six-hour observation
period, represents a combination of the distribution and elimination
phases. Morphine concentrations in the CSF averaged 332��137 ng/mL at 6
hours, following a bolus dose of 0.3 mg of morphine. The apparent volume
of distribution of morphine in the intrathecal space is about 22��8 mL. Time-to-peak plasma
concentrations, however, are similar (5-10 min) after either epidural or
intrathecal bolus administration of morphine. Maximum plasma morphine
concentrations after 0.3 mg intrathecal morphine have been reported from<1 to 7.8 ng/mL. The minimum analgesic morphine plasma
concentration during Patient���Controlled Analgesia (PCA) has been
reported as 20���40 ng/mL, suggesting that any analgesic contribution from
systemic redistribution would be minimal after the first 30���60 minutes
with epidural administration and virtually absent with intrathecal
administration of morphine.
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DURAMORPH is contraindicated in those medical conditions which would preclude the
administration of opioids by the intravenous route���allergy to morphine
or other opiates, acute bronchial asthma, upper airway obstruction. DURAMORPH, like all
opioid analgesics, may cause severe hypotension in an individual whose
ability to maintain blood pressure has already been compromised by a
depleted blood volume or a concurrent administration of drugs, such as
phenothiazines or general anesthetics. (See also PRECAUTIONS: Use
with Other Central Nervous System
Depressants.)
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Preservative-Free
DURAMORPH (morphine sulfate injection, USP) is available in amber DOSETTE ampuls for intravenous, epidural and intrathecal administration: 5 mg/10 mL
(0.5 mg/mL) packaged in 10s (NDC 60977-016-02) 10 mg/10 mL
(1 mg/mL) packaged in 10s (NDC 60977-017-01) Also available from
Baxter: INFUMORPH (Preservative-free Morphine Sulfate Sterile Solution)
200 mg/20 mL (10 mg/mL) and 500 mg/20 mL (25 mg/mL) for epidural and
intrathecal administration via a continuous microinfusion
device.<br/>Storage: PROTECT FROM LIGHT. Store in carton at 20��-
25��C (68��- 77��F), excursions permitted to 15��- 30��C (59��-
86��F) [see USP Controlled Room Temperature] until ready to
use. DO NOT FREEZE. DURAMORPH contains no
preservative or antioxidant. DISCARD ANY UNUSED PORTION. DO NOT
HEAT-STERILIZE. Baxter,
Dosette, Duramorph, and Infumorph are trademarks of Baxter International, Inc., or its subsidiaries. Manufactured by Baxter Healthcare
Corporation Deerfield,
IL 60015 USA For Product
Inquiry 1 800 ANA DRUG (1-800-262-3784) MLT-01070/3.0
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General: Control of
pain by neuraxial opiate delivery is always accompanied by considerable risk to the patients and requires a high level of
skill to be successfully accomplished. The task of treating
these patients must be undertaken by experienced clinical teams,
well-versed in patient selection, evolving technology and
emerging standards of care. For safety reasons, it is
recommended that administration of DURAMORPH by the epidural or
intrathecal routes be limited to the lumbar area. Intrathecal
use has been associated with a higher incidence of respiratory
depression than epidural use. Seizures
may result from high doses. Patients with known seizure disorders should be carefully observed for evidence of
morphine-induced seizure activity.<br/>Use in Patients
with Increased Intracranial Pressure or Head Injury: DURAMORPH
should be used with extreme caution in patients with head injury
or increased intracranial pressure. Pupillary changes (miosis)
from morphine may obscure the existence, extent and course of
intracranial pathology. High doses of neuraxial morphine may
produce myoclonic events (see WARNINGS and ADVERSE
REACTIONS). Clinicians should maintain a high
index of suspicion for adverse drug reactions when evaluating
altered mental status or movement abnormalities in patients
receiving this modality of treatment.<br/>Use in Chronic
Pulmonary Disease: Care is
urged in using this drug in patients who have a decreased
respiratory reserve (e.g., emphysema, severe obesity,
kyphoscoliosis or paralysis of the phrenic nerve). DURAMORPH
should not be given in cases of chronic asthma, upper airway
obstruction or in any other chronic pulmonary disorder without
due consideration of the known risk of acute respiratory failure
following morphine administration in such patients.<br/>Use in Hepatic or
Renal Disease: The
elimination half-life of morphine may be prolonged in patients
with reduced metabolic rates and with hepatic and/or renal
dysfunction. Hence, care should be exercised in administering
DURAMORPH epidurally to patients with these conditions, since
high blood morphine levels, due to reduced clearance, may take
several days to develop.<br/>Use in Biliary
Surgery or Disorders of the Biliary Tract: As significant morphine is released into the systemic circulation
from neuraxial administration, the ensuing smooth muscle
hypertonicity may result in biliary colic.<br/>Use with Disorders
of the Urinary System: Initiation of neuraxial opiate analgesia is frequently associated with
disturbances of micturition, especially in males with prostatic
enlargement. Early recognition of difficulty in urination and
prompt intervention in cases of urinary retention is
indicated.<br/>Use in Ambulatory
Patients: Patients
with reduced circulating blood volume, impaired myocardial
function or on sympatholytic drugs should be monitored for the
possible occurrence of orthostatic hypotension, a frequent
complication in single-dose neuraxial morphine
analgesia.<br/>Use with Other
Central Nervous System Depressants: The
depressant effects of morphine are potentiated by the presence
of other CNS depressants such as alcohol, sedatives,
antihistaminics or psychotropic drugs. Use of neuroleptics in conjunction with neuraxial morphine may increase the risk of
respiratory depression.<br/>Carcinogenesis,
Mutagenesis, Impairment of Fertility: Morphine is
without known carcinogenic or mutagenic effects and is not known
to impair fertility at non-narcotic doses in animals, but
studies of the carcinogenic and mutagenic potential or the
effect on fertility of DURAMORPH have not been
conducted.<br/>Pregnancy:<br/>Teratogenic Effects���Pregnancy Category C: Morphine sulfate is not teratogenic in rats at 35 mg/kg/day (thirty-five times the usual human dose) but does result in increased pup mortality and growth
retardation at doses that narcotize the animal (>10 mg/kg/day, ten times the usual human dose). DURAMORPH
should only be given to pregnant women when no other
method of controlling pain is available and means are at
hand to manage the delivery and perinatal care of the
opiate-dependent infant.<br/>Nonteratogenic Effects: Infants born to mothers who have been taking morphine
chronically may exhibit withdrawal symptoms.<br/>Labor and Delivery: Intravenous morphine readily
passes into the fetal circulation and may result in respiratory
depression in the neonate. Naloxone and resuscitative equipment
should be available for reversal of narcotic-induced respiratory depression in the neonate. In addition, intravenous morphine may
reduce the strength, duration and frequency of uterine
contraction resulting in prolonged labor. Epidurally and intrathecally
administered morphine readily passes into the fetal circulation
and may result in respiratory depression of the neonate.
Controlled clinical studies have shown that epidural administration has
little or no effect on the relief of labor pain.<br/>Nursing Mothers: Morphine is
excreted in maternal milk. Effects on the nursing infant are not
known.<br/>Pediatric Use: Adequate
studies, to establish the safety and effectiveness of spinal
morphine in pediatric patients, have not been performed, and
usage in this population is not recommended.<br/>Geriatric Use: The
pharmacodynamic effects of neuraxial morphine in the elderly are
more variable than in the younger population. Patients will vary
widely in the effective initial dose, rate of development of
tolerance and the frequency and magnitude of associated adverse
effects as the dose is increased. Initial doses should be based
on careful clinical observation following���test doses���, after making due allowances for the effects of the patient's age and infirmity on his/her ability to clear the drug, particularly in
patients receiving epidural morphine. Elderly
patients may be more susceptible to respiratory depression and/or respiratory arrest following administration of
morphine.
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| dailymed-instance:overdosag... |
PARENTERAL ADMINISTRATION OF NARCOTICS IN
PATIENTS RECEIVING EPIDURAL OR INTRATHECAL MORPHINE MAY RESULT IN OVERDOSAGE. Overdosage of
morphine is characterized by respiratory depression, with or without
concomitant CNS depression. In severe overdosage, apnea, circulatory collapse, cardiac arrest and death may occur. Since respiratory arrest
may result either through direct depression of the respiratory center or
as the result of hypoxia, primary attention should be given to the
establishment of adequate respiratory exchange through provision of a
patent airway and institution of assisted, or controlled, ventilation. The narcotic antagonist, naloxone, is a specific antidote. An initial
dose of 0.4 to 2 mg of naloxone should be administered intravenously,
simultaneously with respiratory resuscitation. If the desired degree of
counteraction and improvement in respiratory function is not obtained,
naloxone may be repeated at 2- to 3-minute intervals. If no response is
observed after 10 mg of naloxone has been administered, the diagnosis of
narcotic-induced, or partial narcotic-induced, toxicity should be
questioned. Intramuscular or subcutaneous administration may be used if
the intravenous route is not available. As the duration of
effect of naloxone is considerably shorter than that of epidural or
intrathecal morphine, repeated administration may be necessary. Patients
should be closely observed for evidence of renarcotization.
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| dailymed-instance:genericMe... |
Morphine Sulfate
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| dailymed-instance:fullName |
Duramorph (Injection, Solution)
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| dailymed-instance:adverseRe... |
The most serious
adverse experience encountered during administration of DURAMORPH is
respiratory depression and/or respiratory arrest. This depression and/or
respiratory arrest may be severe and could require intervention. (SeeWARNINGS
and OVERDOSAGE.) Because of delay in maximum CNS effect with
intravenously administered drug (30 min), rapid administration may
result in overdosing. Single-dose neuraxial administration may result in
acute or delayed respiratory depression for periods at least as long as
24 hours.<br/>Tolerance and
Myoclonus: SeeWARNINGS for discussion of these and related
hazards. While low
doses of intravenously administered morphine have little effect
on cardiovascular stability, high doses are excitatory,
resulting from sympathetic
hyperactivity and increase in circulating
catecholamines. Excitation of the central nervous system,
resulting in convulsions,
may accompany high doses of morphine given intravenously.Dysphoric reactions may
occur after any size dose and toxic
psychoses have been reported.<br/>Pruritus: Single-dose
epidural or intrathecal administration is accompanied by a high incidence of pruritus that
is dose-related but not confined to the site of administration. Pruritus, following continuous infusion of epidural or
intrathecal morphine, is occasionally reported in the
literature; these reactions are poorly understood as to their
cause.<br/>Urinary Retention: Urinary
retention, which may persist 10 to 20 hours following single
epidural or intrathecal administration, is a frequent side
effect and must be anticipated primarily in male patients, with
a somewhat lower incidence in females. Also frequently reported
in the literature is the occurrence of urinary retention during
the first several days of hospitalization for the initiation of
continuous intrathecal or epidural morphine therapy. Patients
who develop urinary retention have responded to cholinomimetic
treatment and/or judicious use of catheters .<br/>Constipation: Constipation is frequently encountered during continuous
infusion of morphine; this can usually be managed by
conventional therapy.<br/>Headache: Lumbar
puncture-type headache is encountered in a significant minority
of cases for several days following intrathecal catheter
implantation; this, generally, responds to bed rest and/or other
conventional therapy.<br/>Other: Other
adverse experiences reported following morphine therapy include���Dizziness, euphoria,
anxiety, hypotension, confusion, reduced male potency,
decreased libido in men and women, and menstrual
irregularities including amenorrhea, depression of cough
reflex, interference with thermal regulation andoliguria. Evidence of
histamine release such as urticaria,
wheals and/or local
tissue irritation may occur. Nausea and vomiting
are frequently seen in patients following morphine
administration. Pruritus,
nausea/vomiting and urinary retention, if associated with
continuous infusion therapy, may respond to intravenous
administration of a low dose of naloxone (0.2 mg). The risks of
using narcotic antagonists in patients chronically receiving
narcotic therapy should be considered. In general,
side effects are amenable to reversal by narcotic antagonists.
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| dailymed-instance:warning |
Morphine sulfate
may be habit forming. (See DRUG ABUSE AND
DEPENDENCE.) Overdoses may cause respiratory depression,
coma and death. DURAMORPH
administration should be limited to use by those familiar with the
management of respiratory depression. Rapid intravenous administration may result in chest wall rigidity. Prior to any epidural or intrathecal drug
administration, the physician should be familiar with patient
conditions (such as infection at the injection site, bleeding
diathesis, anticoagulant therapy, etc.) which call for special
evaluation of the benefit versus risk potential. In the case of
epidural or intrathecal administration, DURAMORPH should be administered
by or under the direction of a physician experienced in the techniques
and familiar with the patient management problems associated with
epidural or intrathecal drug administration. Because epidural
administration has been associated with less potential for immediate or
late adverse effects than intrathecal administration, the epidural route should be used whenever possible. SEVERE RESPIRATORY
DEPRESSION UP TO 24 HOURS FOLLOWING EPIDURAL OR INTRATHECAL
ADMINISTRATION HAS BEEN REPORTED. THE FACILITY MUST BE EQUIPPED TO RESUSCITATE PATIENTS WITH SEVERE OPIATE OVERDOSAGE, AND
THE PERSONNEL MUST BE FAMILIAR WITH THE USE AND LIMITATIONS OF SPECIFIC
NARCOTIC ANTAGONISTS (NALOXONE, NALTREXONE) IN SUCH CASES.<br/>Tolerance and
Myoclonic Activity: PATIENTS
SOMETIMES MANIFEST UNUSUAL ACCELERATION OF NEURAXIAL MORPHINE
REQUIREMENTS, WHICH MAY CAUSE CONCERN REGARDING SYSTEMIC ABSORPTION AND THE HAZARDS OF LARGE DOSES; THESE PATIENTS MAY
BENEFIT FROM HOSPITALIZATION AND DETOXIFICATION. TWO CASES OF
MYOCLONIC-LIKE SPASM OF THE LOWER EXTREMITIES HAVE BEEN REPORTED
IN PATIENTS RECEIVING MORE THAN 20 MG/DAY OF INTRATHECAL
MORPHINE. AFTER DETOXIFICATION, IT MIGHT BE POSSIBLE TO RESUME
TREATMENT AT LOWER DOSES, AND SOME PATIENTS HAVE BEEN
SUCCESSFULLY CHANGED FROM CONTINUOUS EPIDURAL MORPHINE TO CONTINUOUS INTRATHECAL MORPHINE. REPEAT DETOXIFICATION MAY BE
INDICATED AT A LATER DATE. THE UPPER DAILY DOSAGE LIMIT FOR EACH
PATIENT DURING CONTINUING TREATMENT MUST BE
INDIVIDUALIZED.
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| dailymed-instance:indicatio... |
DURAMORPH is a
systemic narcotic analgesic for administration by the intravenous,
epidural or intrathecal routes. It is used for the management of pain
not responsive to non-narcotic analgesics. DURAMORPH administered
epidurally or intrathecally, provides pain relief for extended periods
without attendant loss of motor, sensory or sympathetic
function.
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| dailymed-instance:name |
Duramorph
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