Print Friendly, PDF & Email

almostadoctor app banner for android and iOS almostadoctor iPhone, iPad and android apps almostadoctor iOS app almostadoctor android app


Morphine is a commonly used analgesic in acute and chronic pain. It has been around for a very long time!

It can be given intravenously, intramuscularly and orally.

In emergency medicine it is usually given intravenously. On the ward it is often given intramuscularly, particularly in palliative care. In chronic pain it is often given orally.

Failure of morphine is usually due to dose Рnot giving enough! In the emergency setting give it early and give repeated doses if it is not working. There is no maximum dose Рtitrate to effect. Make sure the patient is closely monitored and has oxygen and pulse oximetry. It is easily titrated, and reversible Рwith naloxone Рbut try not to get to that point!



A vial of Morphine
A vial of Morphine

Typical IV morphine doses in the emergency department might include:

  • Children – 0.1mg/Kg IV as an initial dose. Titrate as required
  • Adults – 5mg boluses IV – titrate as required
  • Elderly – 1-2.5mg IV boluses

All patients receiving IV morphine should be on oxygen and pulse oximetry monitoring

In palliative care it is often used in a syringe driver as an IV or IM infusion, with additional bolus doses as required. A typical 24 hour dose might be 10-20mg, with 1-5mg boluses as required.

The use of opiates in chronic pain is widespread, although not without controversy. Opiate dependence is a big problem in many western societies. In the UK, many chronic pain patients, as well as cancer patients, take MST – morphine sulphate. Typical daily doses of MST can be anywhere from 40 – 200mg.

In chronic pain in the absence of cancer, the use of opiates should be discouraged as much as possible and many GPs and pain specialist work hard on ‘de-prescribing’ – slowly reducing the amount of opiates prescribed over time. Going ‘cold-turkey’ is not recommended!


Side Effects

These are similar in all opiates

  • Nausea
  • Itching – due to histamine release
  • Respiratory depression – all patients receiving IV morphine should be on oxygen and pulse oximetry monitoring. Keep an eye on the respiratory rate!
  • Hypotension – thought to be secondary to histamine release

Related Articles

Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

Leave a Reply