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Mitigo
morphine sulfate
Black Box Warnings .
Appropriate Use
should only be prescribed by healthcare professionals knowledgeable about opioid use and how to mitigate assoc. risks; should only be admin. by physicians familiar w/ patient management problems assoc. w/ epidural or intrathecal admin. and should only be given where appropriate monitoring available; proper dosing and titration essential to decr. resp. depression risk
Neuraxial Administration Risk
risk of severe adverse rxns incl. acute or delayed resp. depression up to 24h w/ single-dose epidural or intrathecal admin; observe pts in fully equipped and staffed environment for at least 24h after initial dose and, as appropriate, for 1st several days after catheter implantation
Addiction, Abuse, and Misuse
opioid agonist Schedule II controlled substance w/ risk of addiction, abuse, and misuse, which can lead to overdose and death; assess opioid abuse or addiction risk prior to prescribing; regularly reassess all pts for misuse, abuse, and addiction
Respiratory Depression
serious, life-threatening, or fatal cases may occur even w/ recommended use, esp. during tx start or after dose incr; to decr. risk, initiate and titrate dose appropriately
Risks from Concomitant Use w/ Benzodiazepines, CNS Depressants
concomitant opioid use w/ benzodiazepines or other CNS depressants, incl. alcohol, may result in profound sedation, resp. depression, coma, and death; reserve concomitant use for pts w/ inadequate alternative tx options
Neonatal Opioid Withdrawal Syndrome
extended use in pregnant pts can lead to potentially life-threatening neonatal opioid withdrawal syndrome; advise pregnant pts of risks and ensure tx by neonatology experts avail. at delivery if extended opioid use required
Adult Dosing .
Dosage forms: INJ
pain, mod-severe chronic
- [epidural route, opioid non-tolerant pts]
- Dose: individualize dose via epidural continuous infusion; Start: 3.5-7.5 mg/day epidural continuous infusion; Info: do not use for initial bolus test dose; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C
- [epidural route, opioid tolerant pts]
- Dose: individualize dose via epidural continuous infusion; Start: 4.5-10 mg/day epidural continuous infusion; Info: do not use for initial bolus test dose; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C
- [intrathecal route, opioid non-tolerant pts]
- Dose: individualize dose via intrathecal continuous infusion; Start: 0.2-1 mg/day intrathecal continuous infusion; Info: do not use for initial bolus test dose; epidural admin. preferred; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C
- [intrathecal route, opioid tolerant pts]
- Dose: individualize dose via intrathecal continuous infusion; Start: 1-10 mg/day intrathecal continuous infusion; Info: do not use for initial bolus test dose; epidural admin. preferred; use lowest effective dose, shortest effective tx duration; taper dose gradually to D/C
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- cirrhosis: decr. usual start dose, amount not defined; Info: titrate slowly
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.