Molecular structure of morphine
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Morphine (INN), the principal active agent in opium, is a powerful opioid analgesic drug. Like other opiates, morphine acts directly on the central nervous system (CNS) to relieve pain, and at synapses of the arcuate nucleus, in particular. Side effects include impairment of mental performance, euphoria, drowsiness, lethargy, and blurred vision. It also decreases hunger, inhibits the cough reflex, and produces constipation. Morphine is usually highly addictive, and tolerance and physical and psychological dependence develop quickly. more...

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Patients on morphine often report insomnia and nightmares.

The word derives from Morpheus, the god of dreams in Greek mythology.

Medical use

Administration

Morphine may be given parenterally as subcutaneous, intravenous, or epidural injections. The military sometimes issues morphine loaded in an autoinjector. Morphine can also be administered through a slow-release transdermal patch.

Orally, it comes as an elixir, concentrated solution, powder (for compounding) or in tablet form. Morphine is rarely supplied in suppository form. Due to its poor oral bioavailability, oral morphine is only one-sixth to one-third of the potency of parenteral morphine. Morphine is available in extended-release capsules for chronic administration, as well as immediate-release formulations.

Uses

Morphine is used legally:

  • analgesic in hospital settings for
    • Pain after surgery
    • Pain associated with trauma
  • In the relief of moderate to severe chronic pain
    • Cancer pain
    • Tooth extraction
  • As an adjunct to general anesthesia
  • In epidural anesthesia
  • For palliative care (i.e. to alleviate pain without curing the underlying reason for it)
  • As an antitussive for severe cough
  • As an antidiarrheal in chronic conditions (e.g., for diarrhea associated with AIDS)

Contraindications

  • Acute pancreatitis (this may be a result of morphine use as well)
  • Renal failure (due to accumulation of the metabolite morphine-6-glucuronide)

Pharmacology

Morphine is an opioid agonist whose main effect is binding to the µ-receptors in the central nervous system. This is thought to be the reason behind the analgesia, euphoria, physical dependence and respiratory depression. Morphine also binds with k-receptors, which are thought to mediate spinal analgesia, miosis and sedation.

Legal classification

  • In the United Kingdom, morphine is listed as a Class A drug under the Misuse of Drugs Act 1971.
  • In the United States, morphine is classified as a Schedule II drug under the Controlled Substances Act.
  • Internationally, morphine is a Schedule I drug under the Single Convention on Narcotic Drugs.

History

Morphine was first isolated in 1804 by the German pharmacist Friedrich Wilhelm Adam Sertürner, who named it "morphium" after Morpheus, the Greek god of dreams. But it was not until the development of the hypodermic needle (1853) that its use spread. It was used for pain relief, and as a "cure" for opium and alcohol addiction. Its extensive use during the American Civil War resulted in over 400,000 sufferers from the "soldier's disease" (addiction), though some believe this to be erroneous .

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Ligand Pharmaceuticals Receives FDA Request for AVINZA® Label Changes to Strengthen Warnings About Alcohol Consumption While Using AVINZA
From Business Wire, 7/19/05

SAN DIEGO -- Ligand Pharmaceuticals Incorporated (Nasdaq:LGNDE) today announced receipt of a letter from the Food and Drug Administration (FDA) requesting that the company make changes to the label of its sustained-release opiod product, AVINZA(R) (once-a-day morphine sulfate extended-release capsules).

The FDA letter said, "In vitro observations indicate that the extended-release characteristics of AVINZA are compromised in the presence of alcohol. Until the clinical implications of these data are fully assessed, we request that changes be made to the package insert," with the intent to provide adequate information for the safe and effective use of the drug. The company has also been asked by the FDA to send a "Dear Health Care Professional Letter" to appropriately inform these professionals of the label changes.

"The AVINZA package insert currently carries several precautions about use of the product with alcohol. The FDA suggested changes that would highlight and intensify warnings about alcohol intake while using AVINZA," said James L'Italien, Ph.D., Ligand's senior vice president for regulatory affairs and compliance. "We're analyzing the FDA's request and are in dialogue with the Agency. We may also need to do additional in vivo translational pharmacokinetic studies to accurately assess which of these label changes or clarifications are ultimately appropriate. We intend to work with the FDA to effect agreed upon label changes and the 'Dear Health Care Professional Letter' promptly."

The company will provide an update once this label-change process is complete.

About AVINZA

AVINZA (oral morphine sulfate extended-release capsules) is the first true once-a-day treatment for chronic moderate-to-severe pain in patients who require continuous, around-the-clock opioid therapy for an extended period of time. Approved by the FDA in March 2002, AVINZA consists of two components: an immediate-release component that rapidly achieves plateau morphine concentrations in plasma, and an extended-release component that maintains plasma concentrations throughout a 24-hour dosing interval. Ligand co-promotes AVINZA with Organon Pharmaceuticals USA Inc. in the United States.

About Ligand

Ligand discovers, develops and markets new drugs that address critical unmet medical needs of patients in the areas of cancer, pain, skin diseases, men's and women's hormone-related diseases, osteoporosis, metabolic disorders, and cardiovascular and inflammatory diseases. Ligand's proprietary drug discovery and development programs are based on its leadership position in gene transcription technology, primarily related to intracellular receptors. For more information, go to www.ligand.com.

Caution Regarding Forward-Looking Statements

This news release contains certain forward-looking statements that involve risks and uncertainties and reflect Ligand's judgment as of the date of this release. These statements include those related to discussions with the FDA and AVINZA labeling and possible clinical studies. Actual events or results may differ from our expectations. For example, there can be no assurance that the discussions with the FDA will be successful or that the FDA will not require more stringent package warnings or other actions that could adversely impact AVINZA sales or that the results of any additional clinical studies will not result in other label changes or product actions that could adversely affect the product. Additional information concerning these and other risk factors affecting Ligand can be found in prior press releases as well as in public periodic filings with the Securities and Exchange Commission, available via www.ligand.com. Ligand disclaims any intent or obligation to update these forward-looking statements beyond the date of this release. This caution is made under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.

COPYRIGHT 2005 Business Wire
COPYRIGHT 2005 Gale Group

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