Morphine:
Intravenous opioid
ECMO Dose Adjustment:
YES—an increased dose may be warranted in some patients.
Renal Impairment Dose Adjustment*:
YES—a decreased dose may be warranted in some patients.
CRRT Dose Adjustment:
YES—a decreased dose may be warranted in some patients.
Hepatic Impairment Dose Adjustment*:
YES—a decreased dose may be warranted in some patients.
Adult Starting Dose^:
Adult Intermittent: 0.01-0.15 mg/kg IV every 1-2 hrs (2-4 mg IV every 1-2 hrs)
Adult Continuous Infusion: 0.02-0.05 mg/kg/hr (1–4 mg/hr)
Pediatric Starting Dose^:
Pediatric Intermittent: 0.05-0.1 mg/kg IV every 30-60 min
Pediatric Continuous Infusion: 0.02 mg/kg/hr (20 mcg/kg/hr)
Neonatal Starting Dose^:
Neonatal Intermittent: 0.05-0.1 mg/kg IV every 30-60 min
Neonatal Continuous Infusion: 0.01 mg/kg/hr (10 mcg/kg/hr)
*Dose adjustment will be dependent on acuity and severity of impairment.
^Always use the lowest-effect dose to an objective endpoint (e.g., pain).
Intravenous opioid physicochemical and pharmacokinetic characteristics
Drug Morphine
   
Onset (min) 5-10
Log P 0.9
Protein Binding (%) 30-40
Metabolism / Elimination Hepatic; active metabolite renally eliminated
Dose Adjustment on ECMO ++
Dose Range*
Adult: 0.07-0.5 mg/kg/hr (1-12 mg/hr)
Pediatric: 0.05-0.35 mg/kg/hr
Neonatal: 0.05-0.35 mg/kg/hr
- Minimal sequestration; no need for dose adjustment
++ Moderate sequestration; may require dose adjustment
+++ Significant sequestration; need for dose adjustment
*Titrate to patient-specific goals, using the lowest effective dose. Dose ranges represent doses typically used in clinical practice; in some situations, patients may require doses above the usual dose range to achieve patient-specific goals.