모르핀
Morphine
Morphine sulfate
다른 이름: Astramorph PF · Avinza · DepoDur · Infumorph · Kadian · MSIR · MS Contin · Oramorph SR · RMS · Roxanol · Morphini sulfas · Morphine sulfate · Morphine hydrochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
구조화 용량 계산 근거Analgesia (extra-label) — CRI dosing
인증된 수의사 확인 필요
NA
반드시 함께 고려할 임상 맥락 (5)
- 1. Preservative-free morphine formulations should be used for epidural administration.
- 2. Do not confuse CRI dosages listed as mg/kg/hour with those listed as µg/kg/minute.
- 3. For additional dosages/protocols for using morphine in combination with other drugs (eg, ketamine, lidocaine, dexmedetomidine) for pain/sedation in dogs or cats, see the dosages and their accompanying references in the Dexmedetomidine, Ketamine, and Lidocaine monographs.
- Analgesia (extra-label):
- Morphine injection should be stored at room temperature (20°C-25°F [68°F-77°F]), protected from light; do not freeze. 19 Morphine gradually darkens in color when exposed to light. Morphine does not appear to adsorb to plastic or polyvinyl chloride (PVC) syringes, tubing, or bags.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
모르핀은 수의학에서 중등도에서 중증의 급성 통증 치료에 사용되는 대표적인 오피오이드 진통제입니다. 아편에서 유래한 천연 순수 뮤(μ) 오피오이드 수용체 작용제입니다.
임상 요점 및 종 특이성:
- 개 및 영장류: 모르핀은 일반적으로 예측 가능한 중추신경계 억제, 진정 및 진통을 유발합니다. 화학수용체 방아쇠 영역(CTZ)을 직접 자극하기 때문에 개에게 강력한 구토제로 작용합니다. 개는 종종 초기 투여 직후 배변을 하며, 그 후 위장관 운동이 감소합니다。
- 고양이, 말 및 반추동물: 이들 종은 특히 진정제나 신경안정제(예: 아세프로마진 또는 알파-2 작용제)를 병용하지 않고 투여할 경우 억제보다는 역설적인 중추신경계 흥분(불쾌감, 조증, 서성거림)을 보일 수 있습니다. 고양이에서 구토를 유발하려면 개보다 훨씬 높은 용량이 필요합니다。
- 히스타민 방출: 모르핀은 비만세포에서 비면역학적 히스타민 방출을 유발합니다. 심각한 저혈압, 혈관 확장 및 기관지 수축을 피하기 위해 정맥 주사는 천천히 투여해야 합니다。
- 체온 조절: 모르핀은 개와 토끼에서 저체온증을 유발할 수 있지만, 고양이, 말, 소, 염소에서는 고체온증을 유발합니다。
작용 기전
Morphine acts primarily as a full agonist at the mu (μ) opioid receptors in the central nervous system, with some secondary activity at delta receptors.
- Mechanism: Binding to the G-protein coupled mu-receptor → inhibits adenylate cyclase → decreases intracellular cAMP.
- Presynaptic effect: Closes voltage-gated calcium channels → decreases the release of excitatory nociceptive neurotransmitters (e.g., Substance P, glutamate).
- Postsynaptic effect: Opens inward-rectifying potassium channels → hyperpolarizes the neuron → inhibits ascending pain transmission pathways.
- Secondary effects: Direct stimulation of the chemoreceptor trigger zone (CTZ) causes emesis. Central vagal stimulation leads to bradycardia. Increased anti-diuretic hormone (ADH) release can reduce urine production.
안전성·주의사항
금기사항
- Hypersensitivity to narcotic analgesics
- Patients receiving monoamine oxidase inhibitors (MAOIs)
- Diarrhea caused by a toxic ingestion (until toxin is eliminated)
- Scorpion envenomation (Centruroides spp. - potentiates venom)
- Conditions where vomiting is contraindicated (e.g., raised intraocular pressure)
부작용
- Histamine release (hypotension, vasodilation)
- Bronchoconstriction
- CNS depression (dogs, primates) or excitation (cats, horses, ruminants)
- Physical dependence (with chronic use)
- Hyperthermia (cattle, goats, horses, cats)
- Hypothermia (dogs, rabbits)
- Nausea and vomiting
- Decreased intestinal peristalsis and constipation
- Initial defecation (dogs)
- Panting (dogs)
- Bradycardia or tachycardia
- Histamine release (if given rapidly IV)
- Vomiting (common in non-painful pre-operative patients)
- Transient excitation (IV administration)
- Respiratory depression (especially under general anaesthesia)
- Constriction of gastrointestinal sphincters (e.g., pyloric sphincter)
- Reduction in gastrointestinal motility (with prolonged use)
- Neonatal sedation (crosses the placenta)
주의
Extreme Caution: Patients with head injuries, increased intracranial pressure, acute abdominal conditions (e.g., colic - may mask clinical signs), and respiratory disease or acute respiratory dysfunction.
Caution: Hypothyroidism, severe renal insufficiency (acute uremia), adrenocortical insufficiency (Addison's), and geriatric or severely debilitated patients.
Important Notes:
- IV Administration: Must be given slowly to avoid significant hypotension and histamine release.
- Envenomation: Avoid in envenomation situations, as clinical signs associated with histamine-release can be confused with anaphylaxis.
- Uremia: Because of its effects on vasopressin (ADH), urine flow can decrease by up to 90% in dogs given large doses.
약물 상호작용
May cause increased CNS or respiratory depression when used with morphine.
Opiates may decrease diuretic efficacy in congestive heart failure patients.
Use with extreme caution; contraindicated in humans due to risk of severe opiate overdose signs.
Morphine may enhance neuromuscular blockade.
Morphine may exacerbate the effects of tricyclic antidepressants.
Opiates may potentiate anticoagulant activity.
Increased CNS or respiratory depression
모니터링
- CNS level of depression or excitation
- Blood pressure (especially with IV use)
- Analgesic activity
- Respiratory rate and depth (especially under general anaesthesia)
- Pain scores (to assess individual efficacy)
- Signs of histamine release (hypotension, tachycardia) during IV administration
- Gastrointestinal motility
약동학
반감기
흡수
Absorbed when given by IV, IM, SC, and rectal routes. Very low oral bioavailability (<20%) in dogs due to a high first-pass effect, limiting the clinical usefulness of oral morphine in canines.
분포
Concentrates in the kidney, liver, and lungs; lower levels are found in the CNS. The majority of free morphine is found in skeletal muscle. Crosses the placenta and distributes into maternal milk. Volume of distribution in dogs is ~7.5 L/kg.
대사
Major route of elimination is by metabolism in the liver, primarily by glucuronidation. Cats are deficient in this metabolic pathway, leading to prolonged half-lives.
배설
The active glucuronidated metabolite (M6G) is excreted by the kidney. Clearance in dogs is approximately 83 mL/min/kg.
과다투여
Signs of Toxicity: Overdosage may produce profound respiratory and/or CNS depression in most species. Newborns are more susceptible. Parenteral doses >100 mg/kg are thought to be fatal in dogs. Other toxic effects include cardiovascular collapse, hypothermia, and skeletal muscle hypotonia. Horses, cats, swine, and cattle may demonstrate CNS excitability (hyperreflexia, tremors) and seizures at high doses or if given rapidly intravenously.
Treatment:
- Naloxone is the agent of choice for treating respiratory depression. Doses may need to be repeated as naloxone's effects might diminish before sub-toxic levels of morphine are attained.
- Mechanical respiratory support should be considered in severe cases.
- Pentobarbital has been suggested for CNS excitement and seizures in cats, but extreme caution is required as barbiturates and narcotics have additive respiratory depressant effects.
제품
제형
- Morphine Sulfate for Injection (1-50 mg/mL)
- Liposomal Extended-release Injection (10 mg/mL)
- Preservative-free Injection (0.5-25 mg/mL)
- Soluble Tablets for Injection
- Oral Tablets (15 mg, 30 mg)
- Extended/Controlled Release Tablets (15-200 mg)
- Extended/Sustained Release Capsules (20-200 mg)
- Oral Solution (2-20 mg/mL)
- Rectal Suppositories (5-30 mg)
- Injectable solution: 10 mg/ml, 15 mg/ml, 20 mg/ml, 30 mg/ml
- Oral tablets: 10 mg, 30 mg, 60 mg, 100 mg
- Oral suspensions
- Slow-release capsules
- Granules
인용의약품
- Morphine Sulfate for Injection (1 mg/mL to 50 mg/mL)
- Morphine Sulfate Liposomal Extended-release Injection (DepoDur, 10 mg/mL)
- Morphine Sulfate for Injection, preservative-free (Infumorph, Astramorph PF, 0.5 mg/mL to 25 mg/mL)
- Morphine Sulfate Soluble Tablets for Injection (10 mg, 15 mg, 30 mg)
- Morphine Sulfate Oral Tablets (15 mg, 30 mg)
- Morphine Sulfate Extended/Controlled Release Tablets (MS Contin, Oramorph SR, 15 mg to 200 mg)
- Morphine Sulfate Extended/Sustained Release Capsules (Avinza, Kadian, 20 mg to 200 mg)
- Morphine Sulfate Oral Solution (MSIR, Roxanol, 2 mg/mL to 20 mg/mL)
- Morphine Sulfate Rectal Suppositories (RMS, 5 mg to 30 mg)
- Morphine sulfate injectable solutions
- Morphine sulfate tablets and slow-release capsules
- Morphine suppositories
규제 현황
Methadone is the licensed alternative preferred for bolus administration.
Controlled Drug Schedule 2. Methadone is the licensed alternative.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Oral morphine products should be stored in tight, light-resistant containers at room temperature unless otherwise labeled. Morphine injection should be stored at room temperature, protected from light; do not freeze. Morphine gradually darkens in color when exposed to light; protect from prolonged exposure to bright light.
보호자 정보
모르핀은 강력하고 엄격하게 규제되는 진통제로, 일반적으로 수의사의 직접적인 감독 하에 병원 환경에서 투여됩니다.
- 예상되는 증상: 반려동물이 진정되거나, 졸려 하거나, 평소보다 조용해질 수 있습니다. 개는 종종 심하게 헐떡이며, 약물 투여 직후 구토나 배변을 할 수 있습니다.
- 고양이와 말: 졸려 하기보다는 불안해하거나, 서성거리거나, 눈을 크게 뜨고 있을 수 있습니다. 이는 알려진 종 특이적 차이입니다.
- 가정 내 관리: 경구용 모르핀을 집으로 가져가는 경우, 어린이와 다른 동물의 손이 닿지 않는 곳에 엄격하게 보관하십시오. 이는 고도로 관리되는 약물(스케줄 II)입니다. 수의사와 상의 없이 복용량을 조절하지 마십시오.
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