What is the drug of choice for the treatment of refractory or severe pain associated with myocardial infarction (MI, heart attack), what is the recommended dosage, and which vital signs must be monitored?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Refractory or severe pain should be treated symptomatically with IV morphine.

The initial dose of morphine of 2 to 4 mg as an IV bolus can be given, with increments of 2 to 4 mg repeated every 5 to 10 minutes until the pain is relieved or intolerance is manifested by hypotension, vomiting, or depressed respiration. Should toxicity occur, a morphine antagonist such as naloxone is used for reversal. The patient's blood pressure and pulse must be monitored; the systolic blood pressure must be maintained above 100 mm Hg and, optimally, below 140 mm Hg.

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