Morphine
A strong opioid for severe pain. Titrate IV in small doses, give an antiemetic, and reduce the dose in the elderly and in kidney failure.
On this page
Uses
- Severe acute pain (fractures, renal colic not responding, abdominal pain, burns, MI).
- Breathlessness in palliative care and pulmonary oedema (selected cases).
Adult dose
| Route | Dose |
|---|---|
| IV titration | 1–2.5 mg (elderly) or 2.5–5 mg every 5 minutes until comfortable, then as needed |
| IM or SC | 5–10 mg every 4 hours |
| Oral immediate-release | 5–10 mg every 4 hours when needed |
Children's dose
IV 0.1 mg/kg titrated in increments (0.05 mg/kg in infants), oral 0.2–0.4 mg/kg every 4 hours.
Kidney and liver
Active metabolites accumulate in kidney failure: reduce dose and frequency, or use another opioid.
Pregnancy and breastfeeding
Use when needed; can cause neonatal breathing depression if given near delivery.
Side effects and cautions
- Nausea and vomiting (give an antiemetic), constipation, drowsiness, itch.
- Respiratory depression: monitor; naloxone for reversal.
- Low BP.
Frequently asked questions
How is IV morphine given for acute pain?
In small doses (2.5–5 mg, less in the elderly) every 5 minutes until the pain is controlled.
Why is morphine dangerous in kidney failure?
Its active metabolites build up and cause drowsiness and slow breathing.
Used in these guides
- A patient has fallen
- Acute abdominal pain
- Acute coronary syndrome (heart attack)
- Acute pancreatitis
- Appendicitis
- Bowel obstruction
- Burns
- Chest pain
- Chest pain on the ward
- Compartment syndrome
- Elbow injuries
- Fractures and dislocations: the essentials
- Gallstone disease: colic, cholecystitis, cholangitis
- Haematuria and clot retention
- Hernias in the emergency department
- Hip (neck of femur) fracture
- Open fractures
- Ovarian torsion
- Perforated viscus and peritonitis
- Pneumothorax
- Priapism
- Renal colic (kidney stones)
- Rib injuries
- Shoulder injuries
- Spinal cord compression
Sources
Doses on this page are typical doses from the sources above. Always confirm with a current drug reference, the product leaflet and your hospital protocol, especially in children, pregnancy and kidney or liver disease.
For FCPS Part 1
Revising for FCPS Part 1? Morphine is covered in our textbook chapter Analgesics and NSAIDs, with practice MCQs.