R

Morphinan

R= OH (-) Levorphanol oral = 2 mg R= OCH3 (+) Dextromethorphan

conj = glucuronide or sulfate

Figure 24.8 • Metabolism of morphine and codeine.

conj = glucuronide or sulfate

Figure 24.8 • Metabolism of morphine and codeine.

sulfate salt is formed for both oral, IV, and suppository use. The usual starting parenteral dose of morphine in adults is 2.5 to 5 mg q 4 hours. Morphine is available for oral use both as an immediate release and sustained release formulation. The immediate release preparations are dosed q 4 hours, and the sustained release formulations are dosed q 12 to q 24 hours depending on the formulation.

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