From the FDA Drug Label
Morphine sulfate is contraindicated in patients with respiratory depression in the absence of resuscitative equipment Respiratory depression is the primary risk of morphine sulfate injection. Respiratory depression occurs more frequently in elderly or debilitated patients and in those suffering from conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction, in whom even moderate therapeutic doses may significantly decrease pulmonary ventilation Patients with chronic obstructive pulmonary disease or cor pulmonale and in patients having a substantially decreased respiratory reserve (e.g., severe kyphoscoliosis), hypoxia, hypercapnia, or preexisting respiratory depression have an increased risk of increased airway resistance and decrease respiratory drive to the point of apnea with use of morphine sulfate injection
Morphine is not suitable for patients with Cheyne-Stokes respiration, as it can cause respiratory depression, which may worsen their condition. Key considerations include:
- Respiratory depression: a primary risk of morphine sulfate injection
- Contraindication: in patients with respiratory depression in the absence of resuscitative equipment
- Increased risk: in patients with conditions accompanied by hypoxia, hypercapnia, or upper airway obstruction 1
From the Research
Morphine and other opioid analgesics are generally not suitable for patients with Cheyne-Stokes respiration and should be used with extreme caution if at all. Cheyne-Stokes respiration is characterized by a cyclical pattern of breathing with periods of deep, rapid breaths followed by periods of shallow breathing or apnea. Opioids like morphine can further depress respiratory drive, potentially worsening the abnormal breathing pattern and increasing the risk of respiratory arrest in these vulnerable patients. If pain management is necessary for a patient with Cheyne-Stokes respiration, non-opioid alternatives should be considered first. In situations where opioids cannot be avoided, they should be administered at the lowest effective dose with continuous monitoring of respiratory status and oxygen saturation. The underlying cause of Cheyne-Stokes respiration (such as heart failure, stroke, or brain injury) should be addressed as the primary treatment approach.
Some studies suggest that opioids can be used safely in certain situations, such as for symptomatic relief in advanced-stage patients under palliative care, without significantly compromising respiratory function 2. However, it is essential to note that these studies may not be directly applicable to patients with Cheyne-Stokes respiration, and the potential risks of respiratory depression must be carefully weighed against the benefits of pain management.
Key considerations for managing Cheyne-Stokes respiration include:
- Addressing the underlying cause of the condition, such as heart failure or stroke
- Using non-opioid alternatives for pain management whenever possible
- Administering opioids at the lowest effective dose with continuous monitoring of respiratory status and oxygen saturation if they cannot be avoided
- Considering other therapeutic options, such as supplemental oxygen or nasal continuous positive airway pressure, to help manage the condition.
It is crucial to prioritize the patient's safety and well-being, and to carefully consider the potential risks and benefits of any treatment approach, particularly when it comes to the use of opioids in patients with Cheyne-Stokes respiration.