From the Guidelines
Morphine use should be monitored with regular assessment of pain relief effectiveness, respiratory rate, blood pressure, heart rate, level of sedation, and signs of adverse effects, with follow-up intervals within 1 to 4 weeks of starting long-term opioid therapy or dose escalation, and every 3 months thereafter, as recommended by the CDC guideline for prescribing opioids for chronic pain 1.
Monitoring Parameters
The monitoring parameters for morphine use should include:
- Respiratory rate, with patients monitored for respiratory depression (breathing less than 12 breaths per minute)
- Blood pressure and heart rate
- Level of sedation, using a standardized scale like the Pasero Opioid-Induced Sedation Scale or Richmond Agitation-Sedation Scale
- Signs of adverse effects, such as constipation, nausea, vomiting, urinary retention, and pruritus (itching)
Follow-up Intervals
Follow-up intervals should be:
- Within 1 to 4 weeks of starting long-term opioid therapy or dose escalation
- Every 3 months thereafter, or more frequently for patients at high risk of opioid use disorder or overdose
High-Risk Populations
Monitoring is particularly crucial in high-risk populations, including:
- Elderly patients
- Patients with sleep apnea or respiratory conditions
- Patients taking other CNS depressants
- Patients with a history of substance use disorder or overdose
Additional Considerations
Regular liver and kidney function tests are important, as morphine is metabolized by the liver and excreted by the kidneys, and patients with renal impairment may need dose adjustments to prevent toxicity 1.
From the FDA Drug Label
Monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dosage increases with morphine sulfate and adjust the dosage accordingly [see Warnings and Precautions (5.3)] . Continually reevaluate patients receiving morphine sulfate tablets to assess the maintenance of pain control and the relative incidence of adverse reactions, as well as monitoring for the development of addiction, abuse, or misuse [see Warnings and Precautions (5. 1)] .
The monitoring criteria for morphine use include:
- Respiratory depression: Monitor patients closely, especially within the first 24 to 72 hours of initiating therapy and following dosage increases.
- Pain control: Continually reevaluate patients to assess the maintenance of pain control.
- Adverse reactions: Monitor the relative incidence of adverse reactions.
- Addiction, abuse, or misuse: Monitor for the development of addiction, abuse, or misuse 2.
From the Research
Monitoring Criteria for Morphine Use
The monitoring criteria for morphine use include:
- Respiratory rate: Morphine can cause respiratory depression, which can be life-threatening 3, 4, 5
- Level of consciousness: Morphine can cause somnolence, delirium, and other changes in mental status 6, 7
- Pain scores: Morphine is used to treat pain, and monitoring pain scores can help determine its effectiveness 7
- Nausea and vomiting: Morphine can cause nausea and vomiting, which can be uncomfortable for patients 7
- Oxygen saturation: Morphine can cause respiratory depression, which can lead to decreased oxygen saturation 4
Adverse Events
Adverse events associated with morphine use include:
- Constipation: Morphine can cause constipation, which can be uncomfortable for patients 6
- Dry mouth: Morphine can cause dry mouth, which can be uncomfortable for patients 6
- Anorexia: Morphine can cause anorexia, which can lead to weight loss and other health problems 6
- Dizziness: Morphine can cause dizziness, which can increase the risk of falls 6
- Hallucinations: Morphine can cause hallucinations, which can be disturbing for patients 6
Timing of Monitoring
The timing of monitoring for morphine use is important, as respiratory depression can occur at any time during treatment 3. Monitoring should be frequent enough to detect any changes in respiratory rate or level of consciousness, but not so frequent that it disrupts the patient's rest. The optimal frequency of monitoring is not well established and may depend on individual patient factors, such as age, medical history, and current health status 3.