Description:

Morphine Oral Solution 10mg/5ml (100ml bottle, POM) is a potent opioid analgesic in liquid form, containing morphine sulfate (or hydrochloride in some formulations). It is used for the relief of moderate to severe acute and chronic pain, such as pain from cancer, post-operative recovery, myocardial infarction, or other conditions where milder analgesics are insufficient. The 10mg/5ml concentration (equivalent to 2mg/ml) allows precise dosing with a syringe or spoon. This is a controlled drug (Schedule 2 or equivalent in many countries, including Ghana), with high potential for addiction, dependence, and respiratory depression.

Prescription:

Prescription-only medicine (POM) and a controlled substance (CD – Controlled Drug). In Ghana, it requires a valid prescription from a registered medical practitioner (often a specialist like oncologist or palliative care doctor), with strict dispensing and record-keeping requirements due to its narcotic status. Available in hospital pharmacies or selected licensed community pharmacies in Accra (e.g., Korle Bu Teaching Hospital, private specialist pharmacies), but not freely OTC.

Therapeutic Category:

Opioid Analgesic / Narcotic / Strong Painkiller. Used primarily in palliative care, severe acute pain, and chronic severe pain management.

Active Ingredients/Composition:

• Active ingredient: Morphine sulfate (or morphine hydrochloride) 10 mg per 5 ml (concentration 2 mg/ml). Other typical ingredients (excipients; varies slightly by brand):
• Sucrose (sugar) or sweeteners (for palatability; e.g., 1.5–2.25g per 5ml).
• Ethanol (alcohol) – small amount (e.g., 0.4–0.5ml per 5ml).
• Preservatives (e.g., methyl/ethyl/propyl parahydroxybenzoates).
• Flavoring (e.g., raspberry).
• Purified water, stabilizers, and pH adjusters. The solution is clear, colourless to pale yellow (may darken over time).

Vitamins: None.

Minerals: None.

Variant:

• Standard 10mg/5ml oral solution (100ml bottle is a common small pack size; larger packs like 300ml or 500ml exist). Related variants: Higher concentrations (e.g., 20mg/5ml or 20mg/ml concentrate – only for opioid-tolerant patients), immediate-release tablets, slow-release tablets/capsules, or injectable forms. Brands include Oramorph, generic morphine sulfate solution, or local generics.

Consume Type:

Oral – Solution (liquid; measured with provided syringe, spoon, or dropper; swallow directly or mixed with small amount of water if needed).

Directions/Usage:

Use strictly as prescribed by a doctor (doses are individualized based on pain severity, previous opioid exposure, age, and organ function).

• Adults: Typical starting dose 5–20 mg (2.5–10 ml) every 4 hours as required. Titrate upward gradually under medical supervision; maximum often 120 mg/day initially (but higher in tolerant patients).
• Elderly/renal/hepatic impairment: Start lower (e.g., half dose) and monitor closely.
• Children: Lower doses (e.g., 0.1–0.2 mg/kg every 4 hours for ages 1+; not recommended under 1 year). Use a syringe for accurate measurement (avoid household spoons). Take with or after food if nausea occurs. Do not stop suddenly—taper under supervision to avoid withdrawal. Always use the lowest effective dose for the shortest time.

Common Side Effects:

Very common:

• Constipation (almost universal – laxatives often co-prescribed).
• Nausea/vomiting (especially early).
• Drowsiness/sedation.
• Dizziness, confusion. Common:
• Dry mouth, sweating, itching/rash.
• Respiratory depression (slow/shallow breathing – serious).
• Low blood pressure, urinary retention. Other: Tolerance, dependence/addiction, withdrawal symptoms on stopping. Seek immediate help for severe drowsiness, slow breathing, or confusion.

Package Type:

Amber glass or plastic bottle of 100ml with child-resistant, tamper-evident cap (often includes measuring syringe/spoon). Supplied with patient information leaflet. (Larger 250ml/300ml/500ml bottles available in some markets.)

Storage Advice:

Store below 25–30°C in a cool, dry place, away from direct sunlight, heat, and moisture. Keep tightly closed in original container to protect from light. Do not freeze. Discard 3 months after first opening (or per label). Keep locked/out of reach of children (high overdose risk).

Safety Advice:

• High risk of addiction, misuse, overdose, and fatal respiratory depression – especially in opioid-naïve patients, elderly, or with alcohol/CNS depressants.
• Contraindicated in respiratory depression, severe asthma/COPD, paralytic ileus, acute alcoholism, head injury/coma, or hypersensitivity.
• Caution in pregnancy/breastfeeding (use only if essential), liver/kidney impairment, hypothyroidism, or prostate issues.
• Avoid alcohol, sedatives, or driving/machinery (impairs alertness).
• Monitor for constipation (use laxatives), nausea, or signs of overdose (pinpoint pupils, slow breathing).
• In Ghana: Strictly controlled; report misuse immediately. If overdose suspected (e.g., extreme drowsiness), seek emergency care (naloxone may be needed).

Product Substitutes:

Other morphine oral solutions (10mg/5ml or equivalent) in Ghana:

• Oramorph Oral Solution (branded, common import).
• Generic morphine sulfate oral solution (various importers).
• Alternatives: Codeine linctus (milder), tramadol oral solution, or oxycodone (if available). For severe pain: Controlled-release morphine tablets (e.g., MST Continus), fentanyl patches, or hospital injectables. Consult a palliative care specialist or pharmacist in Accra (e.g., major hospitals like Korle Bu) for availability/suitability.

Manufacturer/Marketer:

Varies by batch: Common manufacturers include Martindale Pharma (UK), Wockhardt (UK/India), or generic producers from India/Egypt. In Ghana, imported by licensed pharmaceutical importers and distributed through hospitals/specialized pharmacies.

Country of Origin:

Primarily United Kingdom (e.g., Martindale/Oramorph) or India (generics); often imported to Ghana via European or Indian suppliers.