* Morphine Contraindications

The following is an abbreviated list of Morphine Contraindications. For complete documentation go to:http://www.themediweb.net/pharmacy/Morphine.htm#1

While reading keep in mind that my mom had lung cancer, COPD, heart disease, hypothyroidism, and she was on full time oxygen because of respiratory depression.

Contraindications for use;

Note: Several of the following conditions may be listed under both ‘contraindications for use’ and ‘cautions for use’ as several different products are included under the one heading. Generally the oral preparations have stricter notes on contraindications than the parenteral preparations. The treating physician/surgeon needs to weigh the benefits of treating vulnerable patients with morphine against the risk of harm to the patient caused by using morphine. Morphine can generally be used if extreme caution is employed in tandem with close patient monitoring and dose titration in the patient groups mentioned below.

• Respiratory depression, head injury, chronic obstructive pulmonary disease (COPD), known morphine sensitivity or sensitivity to any of the ingredients of any morphine preparation, acute hepatic disease and concurrent use or use within 2 weeks of discontinuation of a Monoamine Oxidase Inhibitor antidepressant. Oral preparations in general should not be given to patients with paralytic ileus, an acute abdomen or delayed gastric emptying. Sevredol should additionally not be given in pregnancy and to children aged 3 or under. MST should not be used for post-operative pain in children, in lactating mothers or for administration pre-operatively. MXL should not be given in the first day postoperatively and finally sustained release preparations should not be given within 24 hours pre-operatively to patients undergoing a cordotomy or other pain relieving surgery

Cautions for use;

• The dosage should be reduced in the elderly, in those patients with hypothyroidism and in significant renal or hepatic impairment. Continuous infusions are contraindicated in these patients.

• Morphine should also be used with caution in opiate dependant patients, patients with raised intracranial pressure, hypotension with hypovolaemia, pancreatitis, diseases of the biliary tract, inflammatory bowel disorders, prostatic hypertrophy and adrenocorticoid insufficiency, myxoedema, urethral stricture, acute alcoholism or delerium tremens, Addison’s disease, severe kyphoscoliosis or convulsive disorders. Oral sustained release preparations should not be used postoperatively as intestinal motility is affected and should only be used when the physician/surgeon is satisfied that normal bowel motility has been restored.

• Respiratory depression is the chief hazard of all morphine preparations. It occurs more frequently in elderly and debilitated patients and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may significantly decrease pulmonary ventilation.

• Morphine should be used with extreme caution in patients with COPD or cor pulmonale and in those patients with a substantially decreased respiratory reserve, hypoxia, hypercapnia or pre-existing respiratory depression. In these patients even usual therapeutic doses of morphine may increase airway resistance and decrease respiratory drive to the point of apnoea. Note: Severe pain antagonises the respiratory depressant effects of morphine.