Description

what is morphine sulfate 20 mg/ml

morphine sulfate 20 mg/ml is a pain medication of the opiate family that is found naturally in a dark brown, resinous form, from the poppy plant (Papaver somniferum). It can be taken orally, sublingually, via inhalation, the trans-dermal route, inter-anally as well as via injection (both subcutaneously as well as more commonly inter-venously). morphine acts directly on the central nervous system (CNS) to induce analgesia and alter perception and emotional response to pain. Physical and psychological dependence and tolerance may develop with repeated administration. other morphine sulfate 20 mg/ml uses includes,the cure of acute pain and chronic pain and morphine sulfate can still used to cure pain from myocardial infarction, kidney stones, and during labor. Morphine can be administered by mouth, by injection into a muscle, by injection under the skin, intravenously, injection into the space around the spinal cord, or rectally. Its maximum effect is reached after about 20 minutes when administered intravenously and 60 minutes when administered by mouth, while the duration of its effect is 3–7 hours. Long-acting formulations of morphine sulfate 20 mg/ml Online are available as MS-Contin, Kadian, and other brand names as well as generically morphine.

What is morphine sulfate 20 mg/ml and Description

website…https://lapharmacyonline.com/product/order-morphine-online/

morphine sulfate 20 mg/ml Online New Jersey. Since Morphine abuse can lead to addiction for many years this preparation has been available as a prescription-only drug. However, nowadays licensed web pharmacies are allowed to sell cheap. it is in a pill form. Before you order cheap or buy it with no prescription online, you are to be aware of certain rules related to the usage and dosage of this medicine.

another answer for What is morphine sulfate 20 mg/ml Online or uses is that, The medicated drug (morphine sulfate 20 mg/ml) is used to treat severe pain. This drug belongs to a class of drugs that are associated with opioid (narcotic) painkillers. In the same way, it works in the brain to improve how your body reacts and feels pains and more so, it is taken as a prescribed drug.

Generic name: Morphine

Drug class: opioid analgesics

morphine sulfate 20 mg/ml Online is used to treat severe continuous pain, for example due to cancer. The higher strengths of this drug are 90 and 120 milligrams per capsule. Similarly, it can only be used if you are constantly using medium to large amounts of opioid pain prescriptions.

different morphine sulfate 20 mg/ml Online tablets: These tablets are available in 10 mg, 20 mg or 50 mg.

Tablets (slow acting): 5 mg, 10 mg, 15 mg, 30 mg, 60 mg, 100 mg or 200 mg.

Capsules (slow acting): 10 mg, 30 mg, 60 mg, 90 mg, 120 mg, 150 mg or 200 mg.

Potentially serious side effects of morphine sulfate 20 mg/ml

morphine sulfate 20 mg/ml Online include decreased respiratory effort, vomiting, nausea, and low blood pressure. it is addictive and prone to abuse. If one’s dose is reduced after long-term use, opioid withdrawal symptoms may occur. common side effects includes drowsiness, vomiting, and constipation. Caution is advised for use of morphine during pregnancy or breast feeding, as it may affect the health of the baby.

morphine sulfate 20 mg/ml Online was first isolated between 1803 and 1805 by German pharmacist Friedrich Sertürner. This is generally believed to be the first isolation of an active ingredient from a plant. Merck began marketing it commercially in 1827. this medicine was more widely used after the invention of the hypodermic syringe in 1853–1855. Sertürner originally named the substance morphium, after the Greek god of dreams, Morpheus, as it has a tendency to cause sleep.

The primary source of morphine sulfate 20 mg/ml is isolation from poppy straw of the opium poppy. In 2013, approximately 523 tons of this medicine were produced. Approximately 45 tons were used directly for pain, an increase over 400% the last twenty years. Most use for this purpose was in the developed world. About 70 percent of  morphine sulfate is used to make other opioids such as hydromorphone, oxymorphone, and heroin. It is a Schedule II drug in the United States, Class A in the United Kingdom and Schedule I in Canada. It is on the World Health Organization’s List of Essential Medicines. morphine sulfate 20 mg/ml is sold under many trade names. In 2019, it was the 163rd most commonly prescribed medication in the United States, with more than 3 million prescriptions.

Dosage of morphine sulfate 20 mg/ml Online and method of administration

Dosage can be increased under medical supervision according to the severity of the pain and the patient’s previous history of analgesic requirements.

Special populations:

Reductions in the dosage of this medication may be appropriate in the elderly, and in patients with chronic hepatic disease , renal impairment, severe hypothyroidism, adrenocortical insufficiency, prostatic hypertrophy, shock or where sedation is undesirable.

Method of Administration For oral use.

When patients are transferred from other preparations to morphine sulfate, dosage titration may be appropriate.

morphine sulfate 20 mg/ml is readily absorbed from the gastro-intestinal tract following oral administration. However, when the Oral Solution is used in place of parenterals, a 50% to 100% increase in dosage is usually required in order to achieve the same level of analgesia.

Interactions of morphine sulfate 20 mg/ml with other medicinal products and other forms of interaction.

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors are known to interact with narcotic analgesics producing CNS excitation or depression with hyper- or hypotensive crisis, therefore their concomitant use with morphine sulfate 20 mg/ml in contraindicated.

Gabapentin

Interactions have been reported in those taking the medicine and gabapentin. Reported interactions suggest an increase in opioid adverse events when co-prescribed, the mechanism of which is not known. Caution should be taken where these medicines are co-prescribed.

In a study involving healthy volunteers (N=12), when a 60 mg controlled-release morphine sulfate 20 mg/ml capsule was administered 2 hours prior to a 600 mg gabapentin capsule, mean gabapentin AUC increased by 44% compared to gabapentin administered without morphine. Therefore, patients should be carefully observed for signs of CNS depression, such as somnolence, and the dose of gabapentin should be reduced appropriately.

Ritonavir

Although there are no pharmacokinetic data available for concomitant use of ritonavir with this medicine, ritonavir may increase the activity of glucuronyl transferases. Consequently, co-administration of ritonavir and morphine sulfate may result in decreased serum concentrations with possible loss of analgesic effectiveness.

Rifampicin

Rifampicin can reduce the serum concentration of morphine and decrease its analgesic effect, the mechanism of which is not known.

Cimetidine

CNS depressants

It should be noted that morphine potentiates the effects of CNS depressants such as tranquillisers, anaesthetics , hypnotics, sedatives, antipsychotics, tricyclic antidepressants and alcohol.

Esmolol

morphine sulfate may increase plasma concentrations of esmolol.

Domperidone/ metoclopramide

Opioid analgesics including this drug may antagonise the actions of domperidone and metoclopramide on gastro-intestinal activity.

Mexiletine

The absorption of mexiletine may be delayed by concurrent users of the medicine.

Phenothiazine antiemetics

Phenothiazine antiemetics may be given with morphine. However, hypotensive effects have to be considered.

Voricanazole

Interactions have been reported in those subjects taking the medicine and voriconazole.

Special warnings and precautions for use of morphine side effects preventions

Care should be exercised when given this medicine

– in the first 24 hours post-operatively,

– in hypothyroidism ,and where there is reduced respiratory function such as kyphoscoliosis, emphysema, cor pulmonale and severe obesity.

Asthma

It has been suggested that opioids can be used with caution in controlled asthma. However, opioids are contraindicated in acute asthma exacerbations.

Head injury and increased intracranial pressure

morphine sulfate 20 mg/ml Oral Solution is contraindicated in patients with increased intracranial pressure; head injuries and coma. The capacity of morphine to elevate cerebrospinal fluid pressure may be greatly increased in the presence of already elevated intracranial pressure produced by trauma. Also, the medicine may produce confusion, miosis, vomiting and other adverse reactions which may obscure the clinical course of patients with head injury.

Abdominal conditions

morphine sulfate 20 mg/ml must not be given if paralytic ileus is likely to occur or if the patient has bowel or obstructive biliary disease. Should paralytic ileus be suspected or occur during use. as such ,it should be discontinued immediately.

Caution should be exercised where there is an obstructive bowel disorder, biliary colic, operations on the biliary tract, acute pancreatitis or prostatic hyperplasia.

If constipation occurs, this may be treated with the appropriate laxatives. Care should be exercised in patients with inflammatory bowel disease.

Hypotensive effect

The administration of morphine sulfate 20 mg/ml may result in severe hypotension in individuals whose ability to maintain homeostatic blood pressure has already been compromised by depleted blood volume or the concurrent administration of drugs such as phenothiazine or certain anaesthetics.

Drug dependence and abuse

Tolerance and dependence may occur. Withdrawal symptoms may occur on abrupt discontinuation or on the administration of a narcotic antagonist e.g. naloxone.

this is an opioid agonist and controlled drug. Such drugs are sought by drug abusers and people with addiction disorders. Morphine sulfate can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing morphine sulfate in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse or diversion. it should be used with particular care in patients with a history of alcohol and drug abuse.

morphine sulfate 20 mg/ml may be abused by inhaling or injecting the product. These practices pose a significant risk to the abuser that could result in overdose and death.

Hypersensitivity

Hypersensitivity and anaphylactic reactions have both occurred with the use of this pills. Care should be taken to elicit any history of allergic reactions to opiates. morphine sulfate 20 mg/ml Oral Solution is contraindicated in patients known to be hypersensitive to morphine sulfate.

Risk in special populations

this medicine is metabolised by the liver and should be used with caution in patients with hepatic disease as oral bioavailability may be increased. It is wise to reduce dosage in chronic hepatic and renal disease, severe hypothyroidism, adrenocortical insufficiency, prostatic hypertrophy or shock.

The active metabolite morphine sulfate-6-glucoranide may accumulate in patients with renal failure, leading to CNS and respiratory depression.

Excipient related warnings

Contains the excipients Sodium propyl hydroxybenzoate (E217) and sodium methyl hydroxybenzoate (E219) which are preservatives, and may cause an allergic reaction (possibly delayed).

morphine sulfate 20 mg/ml Oral solution contains alcohol, which is harmful for those suffering from alcoholism. To be taken into account in pregnant or breast-feeding women, children and high-risk groups such as patients with liver disease, or epilepsy.

Pregnancy

Although this medicine has been in general use for many years, there is inadequate evidence of safety in human pregnancy.

it is also known to cross the placenta. Therefore morphine sulfate 20 mg/ml should not be used in pregnancy, especially the first trimester unless the expected benefit is thought to outweigh any possible risk to the foetus.

Infants born from mothers who have been taking morphine sulfate on a chronic basis may exhibit withdrawal symptoms. This should be borne in mind when considering the use of this product in patients during pregnancy.

The risk of gastric stasis and inhalation pneumonia is increased in the mother during labour. Since morphine rapidly crosses the placental barrier it should not be used during the second stage of labour or in premature delivery because of the risk of secondary respiratory depression in the new born infant.

The quantity of ethanol contained in morphine sulfate 20 mg/ml should be considered in pregnant women.

Breast-feeding

Although this medicine has been in general use for many years, there is inadequate evidence of safety during lactation.

this medication is not recommended for nursing mothers. morphine sulfate 20 mg/ml is excreted in breast milk, and may thus cause respiratory depression in the new born infant.

Fertility

Long term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility and erectile dysfunction.

Signs of morphine sulfate 20 mg/ml toxicity and over dosage are likely to consist of pin-point pupils, respiratory depression and hypotension. Circulatory failure and deepening coma may occur in more severe cases. Convulsions may occur in infants and children. Death may occur from respiratory failure.

Treatment:

Adults: Administer 0.4-2 mg of naloxone intravenously. Repeat at 2-3 minute intervals as necessary to a maximum of 10 mg, or by an infusion of 2 mg in 500 ml of normal saline or 5 % dextrose (4 micrograms/ml).

Children: 5-10 micrograms per kilogram body weight of naloxone intravenously. If this does not result in the desired degree of clinical improvement, a subsequent dose of 100 mcg/kg body weight may be administered.

Care should always be taken to ensure that the airway is maintained. Assist respiration if necessary. Maintain fluid and electrolyte levels Oxygen, i.v. fluids, vasopressors and other supportive measures should be employed as indicated. Peak plasma concentrations of morphine sulfate are expected to occur within 15 minutes of oral ingestion. Therefore gastric lavage and activated charcoal are unlikely to be beneficial.

Caution: the duration of the effect of naloxone(2-3 hours) may be shorter than the duration of the effect of morphine sulfate 20 mg/ml overdose. It is recommended that a patient who has regained consciousness after naloxone treatment should be observed for at least 6 hours after the last dose of naloxone.

Components:

Morphine Sulfate

Method of action:

Analgesic,Antitussive,Hypnotic,Opioid

Treatment option:

Insomnia, Pain, Cough, Dyspnea, Crush Injury

Medically reviewed by Oliinyk Elizabeth Ivanovna, PharmD. Last updated on 2020-04-09

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Oral Solution Therapeutic indications

For the relief of severe pain.

morphine sulfate 20 mg/ml Dosage and method of administration

Posology

Adults:	Recommended dose: 10-20 mg (5-10 ml) every 4 hours.
	Maximum daily dose: 120 mg per day
Paediatric population:
Children 13 to 18 years	Recommended dose: 5-20 mg (2.5-10 ml) every 4 hours,
	Maximum daily dose: 120 mg per day
Children 6-12 years:	Recommended dose: 5-10 mg (2.5-5 ml) every 4 hours,
	Maximum daily dose:60 mg per day
Children 1-5 years:	Recommended dose 5 mg (2.5 ml) every 4 hours.
	Maximum daily dose: 30 mg per day

Children under 1 year: Not recommended.

Dosage can be increased under medical supervision according to the severity of the pain and the patient’s previous history of analgesic requirements.

Special populations:

Reductions in dosage may be appropriate in the elderly, and in patients with chronic hepatic disease , renal impairment, severe hypothyroidism, adrenocortical insufficiency, prostatic hypertrophy, shock or where sedation is undesirable.

Method of Administration For oral use.

When patients are transferred from other drugs preparations to Morphine dosage titration may be appropriate.

morphine sulfate 20 mg/ml is readily absorbed from the gastro-intestinal tract following oral administration. However, when this Oral Solution is used in place of parenteral morphine, a 50% to 100% increase in dosage is usually required in order to achieve the same level of analgesia. Contraindications

this medicine is contraindicated in:

– patients known to be hypersensitive to this medicine or to any other component of the product

– respiratory depression

– obstructive airways disease

– acute hepatic disease,

– acute alcoholism,

– head injuries

– coma

– convulsive disorders

– increased intracranial pressure

– paralytic ileus

– patients with known morphine sensitivity

– concurrent administration with monoamine oxidase inhibitors or within two weeks of discontinuation of their use

– patients with phaeochromocytoma. this medicine and some other opioids can induce the release of endogenous histamine and thereby stimulate catecholamine release

– )Special warnings and precautions for use

Care should be exercised if medication is given

– in the first 24 hours post-operatively,

– in hypothyroidism ,and where there is reduced respiratory function such as kyphoscoliosis, emphysema, cor pulmonale and severe obesity.

Asthma

It has been suggested that opioids can be used with caution in controlled asthma. However, opioids are contraindicated in acute asthma exacerbations.

Head injury and increased intracranial pressure

morphine sulfate 20 mg/ml is contraindicated in patients with increased intracranial pressure; head injuries and coma. The capacity of morphine to elevate cerebrospinal fluid pressure may be greatly increased in the presence of already elevated intracranial pressure produced by trauma. Also, this medicine may produce confusion, miosis, vomiting and other adverse reactions which may obscure the clinical course of patients with head injury.

Abdominal conditions

Morphine sulfate must not be given if paralytic ileus is likely to occur or if the patient has bowel or obstructive biliary disease. Should paralytic ileus be suspected or occur during use, this Oral Solution should be discontinued immediately.

Caution should be exercised where there is an obstructive bowel disorder, biliary colic, operations on the biliary tract, acute pancreatitis or prostatic hyperplasia.

If constipation occurs, this may be treated with the appropriate laxatives. Care should be exercised in patients with inflammatory bowel disease.

it may obscure the diagnosis or clinical course of patients with acute abdominal conditions and complications following abdominal surgery.

Hypotensive effect

The administration of this medicine may result in severe hypotension in individuals whose ability to maintain homeostatic blood pressure has already been compromised by depleted blood volume or the concurrent administration of drugs such as phenothiazine or certain anaesthetics.

Drug dependence and abuse

Tolerance and dependence may occur. Withdrawal symptoms may occur on abrupt discontinuation or on the administration of a narcotic antagonist e.g. naloxone.

morphine sulfate 20 mg/ml is an opioid agonist and controlled drug. Such drugs are sought by drug abusers and people with addiction disorders. it can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing morphine in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse or diversion. it should be used with particular care in patients with a history of alcohol and drug abuse.

the medication may be abused by inhaling or injecting the product. These practices pose a significant risk to the abuser that could result in overdose and death.

Hypersensitivity

Hypersensitivity and anaphylactic reactions have both occurred with the use of morphine sulfate 20 mg/ml. Care should be taken to elicit any history of allergic reactions to opiates. this Oral Solution is contraindicated in patients known to be hypersensitive.

Risk in special populations

morphine sulfate is metabolised by the liver and should be used with caution in patients with hepatic disease as oral bioavailability may be increased. It is wise to reduce dosage in chronic hepatic and renal disease, severe hypothyroidism, adrenocortical insufficiency, prostatic hypertrophy or shock.

The active metabolite Morphine-6-glucoranide may accumulate in patients with renal failure, leading to CNS and respiratory depression.

Excipient related warnings

Contains the excipients Sodium propyl hydroxybenzoate (E217) and sodium methyl hydroxybenzoate (E219) which are preservatives, and may cause an allergic reaction (possibly delayed).

this Oral solution pills contains alcohol, which is harmful for those suffering from alcoholism. To be taken into account in pregnant or breast-feeding women, children and high-risk groups such as patients with liver disease, or epilepsy.

Interaction with other medicinal products and other forms of interaction

Monoamine oxidase inhibitors

Monoamine oxidase inhibitors are known to interact with narcotic analgesics producing CNS excitation or depression with hyper- or hypotensive crisis, therefore their concomitant use with this medicine is contraindicated.

Gabapentin

Interactions have been reported in those taking morphine sulfate and gabapentin. Reported interactions suggest an increase in opioid adverse events when co-prescribed, the mechanism of which is not known. Caution should be taken where these medicines are co-prescribed.

In a study involving healthy volunteers (N=12), when a 60 mg controlled-release morphine capsule was administered 2 hours prior to a 600 mg gabapentin capsule, mean gabapentin AUC increased by 44% compared to gabapentin administered without morphine. Therefore, patients should be carefully observed for signs of CNS depression, such as somnolence, and the dose of gabapentin or morphine should be reduced appropriately.

Ritonavir

Although there are no pharmacokinetic data available for concomitant use of ritonavir with this medicine, ritonavir may increase the activity of glucuronyl transferases. Consequently, co-administration of ritonavir and morphine may result in decreased serum concentrations of morphine with possible loss of analgesic effectiveness.

Rifampicin

Rifampicin can reduce the serum concentration of morphine and decrease its analgesic effect, the mechanism of which is not known.

Cimetidine

Cimetidine inhibits the metabolism of morphine sulfate.

CNS depressants

It should be noted that this medicine potentiates the effects of CNS depressants such as tranquillisers, anaesthetics , hypnotics, sedatives, antipsychotics, tricyclic antidepressants and alcohol.

Esmolol

this medicine may increase plasma concentrations of esmolol.

Domperidone/ metoclopramide

Opioid analgesics including this drug may antagonise the actions of domperidone and metoclopramide on gastro-intestinal activity.

Mexiletine

The absorption of mexiletine may be delayed by concurrent use of opiod.

Phenothiazine antiemetics

Phenothiazine antiemetics may be given with morphine sulfate 20mg. However, hypotensive effects have to be considered.

Voricanazole

Interactions have been reported in those subjects taking this medicine and voriconazole. Fertility, pregnancy and lactation

Pregnancy

Although morphine sulfate has been in general use for many years, there is inadequate evidence of safety in human pregnancy.

morphine sulfate is known to cross the placenta. Therefore this Oral Solution should not be used in pregnancy, especially the first trimester unless the expected benefit is thought to outweigh any possible risk to the foetus.

Infants born from mothers who have been taking morphine on a chronic basis may exhibit withdrawal symptoms. This should be borne in mind when considering the use of this Oral Solution in patients during pregnancy.

The risk of gastric stasis and inhalation pneumonia is increased in the mother during labour. Since morphine rapidly crosses the placental barrier it should not be used during the second stage of labour or in premature delivery because of the risk of secondary respiratory depression in the new born infant.

The quantity of ethanol contained in this medicine should be considered in pregnant women.

Breast-feeding

Although morphine sulfate has been in general use for many years, there is inadequate evidence of safety during lactation.

this medicine is not recommended for nursing mothers. Morphine is excreted in breast milk, and may thus cause respiratory depression in the new born infant.

Fertility

Long term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility and erectile dysfunction.Effects on ability to drive and use machines

this sulfate is likely to impair ability to drive and to use machinery. This effect is even more enhanced, when used in combination with alcohol or CNS depressants. Patients should be warned not to drive or operate dangerous machinery after taking this Oral Solution pills.

This medicine can impair cognitive function and can affect a patient’s ability to drive safely. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988. When prescribing this medicine, patients should be told:

– The medicine is likely to affect your ability to drive

– Do not drive until you know how the medicine affects you

– It is an offence to drive while under the influence of this medicine

– However, you would not be committing an offence (called ‘statutory defence’) if:

o The medicine has been prescribed to treat a medical or dental problem and

o You have taken it according to the instructions given by the prescriber and in the information provided with the medicine and

o It was not affecting your ability to drive safely

Absorption

this medication is modestly absorbed from the gastrointestinal tract following oral administration. Following oral administration of radio labelled morphine sulfate to humans, peak plasma levels were reached after approximately 15 minutes. Morphine undergoes significant first pass metabolism in the liver resulting in a systemic bioavailability of approximately 25%.

Distribution

Approximately one third of morphine in the plasma is protein bound after a therapeutic dose.

Biotransformation

Metabolism of morphine sulfate principally involves conjugation to morphine 3- and 6- glucuronides. Small amounts are also metabolised by N-demethylation and N-dealkylation. Morphine-6-glucuronide has pharmacological effects indistinguishable from those of morphine. The half-life of morphine is approximately 2 hours. The t1/2 of morphine-6- glucuronide is somewhat longer.

Elimination

A small amount of a dose of morphine sulfate 20 mg/ml is excreted through the bowel into the faeces. The remainder is excreted in the urine, mainly in the form of conjugates. Approximately 90 % of a single dose of morphine is excreted in the first 24 hours. Enterohepatic circulation of morphine and its metabolites can occur, and may result in small quantities of morphine to be present in the urine or faeces for several days after the last dose.

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