What is the treatment for a morphine overdose?

From the Guidelines

The treatment for a morphine overdose primarily involves administering naloxone, an opioid antagonist that rapidly reverses the effects of opioids, at a dose of 0.4-2 mg intravenously, intramuscularly, or intranasally, as recommended by the most recent guidelines 1.

Key Considerations

• For suspected overdose, naloxone should be given immediately, and if there's no response within 2-3 minutes, additional doses can be administered.
• After initial reversal, continued monitoring is essential as naloxone's effects may wear off before the morphine is fully metabolized, potentially causing the overdose symptoms to return, as noted in the 2020 American Heart Association guidelines 1.
• Supportive care is also crucial, including maintaining the airway, providing supplemental oxygen, and supporting breathing with bag-valve-mask ventilation or intubation if necessary, as outlined in the 2010 American Heart Association guidelines 1.

Administration and Monitoring

• The duration of action of naloxone is approximately 45 to 70 minutes, but respiratory depression caused by ingestion of a long-acting opioid may last longer, requiring repeat doses of naloxone or a naloxone infusion, as recommended by the 2020 guidelines 1.
• Patients who respond to naloxone administration may develop recurrent CNS and/or respiratory depression, and longer periods of observation may be required to safely discharge a patient with life-threatening overdose of a long-acting or sustained-release opioid, as noted in the 2015 American Heart Association guidelines update 1.

Special Considerations

• Naloxone administration should begin with a low dose (0.04 to 0.4 mg), with repeat dosing or dose escalation to 2 mg if the initial response is inadequate, as recommended by the 2010 guidelines 1.
• Patients with life-threatening central nervous system or respiratory depression reversed by naloxone administration should be observed for resedation, and the patient should be monitored for at least 4-6 hours, and longer observation may be necessary for large overdoses or extended-release formulations, as outlined in the example answer.

From the FDA Drug Label

1. 2 Treatment Give primary attention to the reestablishment of adequate respiratory exchange through provision of a patent airway and institution of assisted, or controlled, ventilation. Employ supportive measures (including oxygen and vasopressors) in the management of circulatory shock and pulmonary edema accompanying overdose as indicated Cardiac arrest or arrhythmias may require cardiac massage or defibrillation. The pure opioid antagonist naloxone is a specific antidote to respiratory depression resulting from opioid overdose.

The treatment for a morphine overdose involves:

• Reestablishing adequate respiratory exchange through a patent airway and assisted or controlled ventilation
• Employing supportive measures, such as oxygen and vasopressors, to manage circulatory shock and pulmonary edema
• Cardiac massage or defibrillation for cardiac arrest or arrhythmias
• Administration of naloxone, a pure opioid antagonist, as a specific antidote to respiratory depression resulting from opioid overdose 2

From the Research

Morphine Overdose Treatment

• The treatment for a morphine overdose typically involves the administration of naloxone, an opioid antagonist that can reverse the effects of an opioid overdose 3, 4, 5, 6.
• Naloxone can be administered via various routes, including intramuscularly, intravenously, and intranasally, with the choice of route depending on the specific circumstances of the overdose 3, 5, 6.
• The dose of naloxone required to reverse an opioid overdose can vary, but a common dose is 0.04 mg to 2 mg, with the possibility of repeat doses if necessary 4, 5.
• It is essential to note that naloxone can precipitate acute opioid withdrawal syndrome in individuals who are opioid-dependent, and therefore, it should be used with caution and in a controlled environment 4, 7.

Administration Routes and Dosing

• Studies have compared the efficacy of different administration routes, including intranasal and intramuscular naloxone, with mixed results 5, 6.
• One study found that higher-concentration intranasal naloxone (2 mg/mL) had similar efficacy to intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events 5.
• Another study found that lower-concentration intranasal naloxone (2 mg/5 mL) was less effective than intramuscular naloxone but was associated with decreased risk for agitation 5.

Safety and Adverse Events

• Naloxone is generally considered a safe medication, but it can cause adverse events, including precipitation of acute opioid withdrawal syndrome, hypoxia, and direct myocardial depressant effects 4, 7.
• One case report described a preterm neonate who developed cardiac arrest following treatment with naloxone for a morphine overdose, highlighting the potential risks of naloxone in certain populations 7.
• Studies have also reported low rates of death and serious adverse events in patients who received naloxone for opioid overdose in out-of-hospital settings, with few patients requiring admission to the hospital 5, 6.