Morphine

ATC code

N02AA01

Therapeutic class

Opioid analgesic · Natural opium alkaloid

Forms

injectable solution, oral tablet (immediate-release), oral tablet (extended-release), oral solution, rectal suppository

Brand names

Morfina B. Braun (ES) · MS Contin (US) · Kadian (US) · Duramorph (US) · Sevredol (FR) · Actiskenan (FR)

Overall confidence

medium

Regulatory sources consulted

AEMPS CIMA Ficha Técnica: 82748
https://cima.aemps.es/cima/dochtml/ft/82748/FT_82748.html
PubMed PMID:40145987 ↗
PubMed PMID:37678451 ↗
PubMed PMID:35849756 ↗
CredibleMeds.org
Clinical Pharmacology Knowledge Base
AEMPS CIMA · nº registro 82748 ↗

Approved indications

Management of severe pain, acute or chronic, that is not responsive to non-opioid analgesics.

Contraindications

Absolute

Hypersensitivity to morphine.
Respiratory depression or severe obstructive respiratory disease.
Paralytic ileus or suspicion thereof.
Acute or severe bronchial asthma.
Severe hepatocellular insufficiency.

Clinical warnings

Boxed warning · Addiction, Abuse, and Misuse: Risk of overdose and death. Assess each patient's risk prior to prescribing and monitor all patients regularly. — FDA
Boxed warning · Life-Threatening Respiratory Depression: Monitor for respiratory depression, especially during initiation or following a dose increase. — FDA
Boxed warning · Neonatal Opioid Withdrawal Syndrome: Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening. — FDA

Drug interactions

HighBenzodiazepines and other CNS depressantsN05BA
Mechanism: Pharmacodynamic synergy that potentiates respiratory depression, profound sedation, coma, and death.
Recommendation: Avoid concomitant use. If necessary, prescribe the lowest effective doses for the shortest possible duration and monitor patients closely.
FDA label
HighMonoamine Oxidase Inhibitors (MAOIs)N06AF
Mechanism: Unclear mechanism, may involve potentiation of serotonergic and noradrenergic effects, causing serotonin syndrome or opioid toxicity.
Recommendation: Concomitant use or use within 14 days of stopping an MAOI is contraindicated.
AEMPS CIMA

Adverse events

Common (≥1%)

constipation · nausea · vomiting · somnolence · dizziness · sedation · diaphoresis · pruritus · confusion

Rare but serious

severe respiratory depression · severe hypotension · syncope · paralytic ileus · anaphylaxis · adrenal insufficiency

Pregnancy and lactation

Prolonged use during pregnancy can cause neonatal opioid withdrawal syndrome. Not recommended for use during labor due to risk of respiratory depression in the neonate. Morphine is excreted in breast milk; breastfeeding is not recommended.

Recent literature (PubMed)

Ice Packing Versus Warm Sitz Baths for Post-hemorrhoidectomy Pain Management: A Randomized Controlled Trial.
Chen PC, et al. · Dis Colon Rectum · 2025 · Relevance 4/5
Este ECA comparó compresas de hielo con baños de asiento tibios para el dolor post-hemorroidectomía. El grupo de hielo tuvo menores puntuaciones de dolor, menos hinchazón, mejor cicatrización y un menor consumo de morfina en 24 horas (4.58 mg vs 6.39 mg), sugiriendo que el frío es una estrategia superior para reducir el dolor y el uso de opioides en este contexto.
Implications of different analgesic models on inflammatory markers after laparoscopic cholecystectomy.
Hamed E, et al. · Rev Esp Anestesiol Reanim (Engl Ed) · 2023 · Relevance 4/5
ECA que evaluó diferentes técnicas de analgesia local en colecistectomía laparoscópica. El grupo que recibió una infiltración de bupivacaína, morfina (3 mg) y ketamina mostró la mejor analgesia y la menor respuesta inflamatoria, destacando el beneficio de la morfina como parte de un enfoque analgésico multimodal local.
Liposomal Bupivacaine Transversus Abdominis Plane Blocks in Laparoscopic Colorectal Resections: A Single-Institution Randomized Controlled Trial.
Chevrollier GS, et al. · Dis Colon Rectum · 2023 · Relevance 3/5
Este ECA comparó bupivacaína liposomal vs. estándar en bloqueos del plano transverso del abdomen para cirugía colorrectal. No se encontraron diferencias significativas en el consumo de equivalentes de miligramos de morfina (MME) entre los grupos, lo que sugiere que la formulación liposomal no ofreció un beneficio de ahorro de opioides en este estudio.