Morphine in the setting of acute myocardial infarction: pros and cons

• Published in: The American journal of emergency medicine Vol. 34; no. 4; pp. 746 - 748
• Main Authors: Zhang, Nixiao, Chen, Kangyin, MD, PHD, Rha, Seung-Woon, MD, PHD, Li, Guangping, MD, PHD, Liu, Tong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016; Elsevier Limited
• Subjects: Acute coronary syndromes; Analgesics; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Anti-inflammatory agents; Cardiology; Chest Pain - drug therapy; Chest Pain - etiology; Clinical medicine; Clinical trials; Digestive glands; Drug dosages; Drug use; Emergency; Emergency medical care; Emergency Service, Hospital; Heart attacks; Hospitalization; Humans; Ischemia; Morphine - adverse effects; Morphine - therapeutic use; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Narcotics; Nonsteroidal anti-inflammatory drugs; Pain; Studies; Substance abuse treatment
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.01.016

Importantly, morphine slows gastric peristalsis and suppresses the secretion of digestive glands, including intestinal and pancreatic secretions, leading to delayed drug absorption. [...]nausea, vomiting, and constipation are also common adverse effects of morphine used in patients with AMI. If chest pain persists after intravenous beta-blockers, standard doses of morphine use relieve pain better than increased dosages of metoprolol [23]. [...]other analgesic drugs, like nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors, are contraindicated in AMI patients because of increased risk of death and adverse outcomes assessed by several epidemiological studies and retrospective analyses of randomized related trials [4].