No

Analgesic, Narcotic; Antidiarrheal

Treatment of diarrhea or relief of pain

C-II

B/D (if used for prolonged periods or in high doses at term)

Increased intracranial pressure, severe respiratory depression, severe liver or renal insufficiency, known hypersensitivity to morphine sulfate

Opium shares the toxic potential of opiate agonists, and usual precautions of opiate agonist therapy should be observed; some preparations contain sulfites which may cause allergic reactions; infants <3 months of age are more susceptible to respiratory depression, use with caution and generally in reduced doses in this age group; this is not paregoric, dose accordingly

>10%:

Cardiovascular: Palpitations, hypotension, bradycardia

Central nervous system: Drowsiness, dizziness

Neuromuscular & skeletal: Weakness

1% to 10%:

Central nervous system: Restlessness, headache, malaise

Genitourinary: Decreased urination

Miscellaneous: Histamine release

<1%: Peripheral vasodilation, CNS depression, increased intracranial pressure, insomnia, mental depression, nausea, vomiting, constipation, anorexia, stomach cramps, biliary tract spasm, urinary tract spasm, miosis, respiratory depression, physical and psychological dependence

Primary attention should be directed to ensuring adequate respiratory exchange; opiate agonist-induced respiratory depression may be reversed with parenteral naloxone hydrochloride

Decreased effect: Phenothiazines may antagonize the analgesic effect of opiate agonists

Increased toxicity: CNS depressants, MAO inhibitors, tricyclic antidepressants may potentiate the effects of opiate agonists; dextroamphetamine may enhance the analgesic effect of opiate agonists

Protect from light

Contains many narcotic alkaloids including morphine; its mechanism for gastric motility inhibition is primarily due to this morphine content; it results in a decrease in digestive secretions, an increase in GI muscle tone, and therefore a reduction in GI propulsion

Duration of effect: 4-5 hours

Absorption: Variable from GI tract

Metabolism: In the liver

Elimination: Urine

Oral:

Diarrhea: 0.005-0.01 mL/kg/dose every 3-4 hours for a maximum of 6 doses/24 hours

Analgesia: 0.01-0.02 mL/kg/dose every 3-4 hours

Adults:

Diarrhea: 0.3-1 mL/dose every 2-6 hours to maximum of 6 mL/24 hours

Analgesia: 0.6-1.5 mL/dose every 3-4 hours

Alcohol: Additive CNS effect, avoid use

Observe patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation

aminotransferase [ALT (SGPT)/AST (SGOT)] (S)

Dizziness and drowsiness are common; may cause restlessness; may rarely cause insomnia or depression

Concurrent use with psychotropics may alter the analgesic effects of opioids; monitor for altered response

No information available to require special precautions

No effects or complications reported

If self-administered, use exactly as directed (do not increase dose or frequency); may cause physical and/or psychological dependence. While using this medication, do not use alcohol and other prescription or OTC medications (especially sedatives, tranquilizers, antihistamines, or pain medications) without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May cause hypotension, dizziness, drowsiness, impaired coordination, or blurred vision (use caution when driving, climbing stairs, or changing position - rising from sitting or lying to standing, or when engaging in tasks requiring alertness until response to drug is known); dry mouth (frequent mouth care, small frequent meals, chewing gum, or sucking lozenges may help). Report slow or rapid heartbeat, acute dizziness, or persistent headache; changes in mental status; swelling of extremities or unusual weight gain; changes in urinary elimination or pain on urination; acute headache; trembling or muscle spasms; blurred vision; skin rash; or shortness of breath. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. If you are breast-feeding, take medication immediately after breast-feeding or 3-4 hours prior to next feeding.

Monitor patient for excessive sedation, respiratory depression, implement safety measures, assist with ambulation

Liquid: 10% [0.6 mL equivalent to morphine 6 mg]

Kraus DM and Hatzopoulos FK, "Neonatal Therapy," Applied Therapeutics: The Clinical Use of Drugs, 6th ed, Young LY and Koda-Kimble MA, eds, Vancouver, WA: Applied Therapeutics, Inc, 1995.

Levy M and Spino M, "Neonatal Withdrawal Syndrome: Associated Drugs and Pharmacologic Management," Pharmacotherapy, 1993, 13(3):202-11.