The word "morphine" (or the obsolete name "morphine") is known to almost everyone. But few people are familiar with the specifics of this substance and know about its properties. In the minds of most people, it is strongly associated with drugs. But is it really so?

Morphine business card

In medical terms, morphine is considered an opium alkaloid. Its content is found in the hypnotic poppy, moonseed, stephania.

It is quite rare in varieties such as triclisia, croton, okotea. Getting morphine is not difficult. The substance is easily obtained from latex (dried juice), after finely chopping immature poppy pods. This alkaloid is found in opium in the form of sulfuric and lactic acids, as well as meconium salt. Its concentration can reach 26%, but on average this figure does not exceed 12%.

Origin of morphine

Morphine was first obtained at the very beginning of the 19th century. The progenitor of the substance is considered to be the German chemist Friedrich Serturner, who discovered this drug in 1804. But the finest hour of morphine came much later - in 1857, when the first syringe was invented.

The German scientist considered it a good sleeping pill, and therefore gave the name to the substance in honor of Greek god Morpheus. In addition, according to Serturner, this drug was a good substitute for opium, as a result of which it was successfully used to treat opiomania. The positive results have led to dangerous consequences use of the substance was not detected immediately.

No matter how paradoxical it may sound, but its creator also became a victim of morphine. However, Serturner only towards the end of his life realized what was the cause of his ailment. It turned out that morphine is even more addictive than opium. Thus, in 1874, a new term arose - morphinism, meaning dependence on morphine. Moreover, psychological dependence occurs very quickly, physical - a little slower.

Morphine - indications for use

However, in the case of morphine, not everything is so simple. If it is not abused, then it does not show its negative properties. This drug is still used in modern medicine. It is a white crystal, which over time can become yellowish. The drug is produced in tablets, ampoules and syringe tubes. Most often, the substance is used in the form of injections. Depending on the doctor's prescription, it can be administered intravenously, intramuscularly, subcutaneously.

Indications for use can be called:

• Severe physical pain, for example, with myocardial infarction, with injuries, malignant tumors.
• With severe shortness of breath, cough, which are caused by heart failure.
• Before preparation for operations or in the postoperative period.
• With insomnia, especially if it is caused by severe pain.
• In X-ray examinations of the intestine to detect tumors or ulcers.

Morphine acts directly on the nervous system, thereby reducing pain. A physically healthy person, without diseases of the lungs and heart, can easily endure drug withdrawal. However, in such cases, sometimes there are Negative consequences: epileptic seizures, convulsions, suicide. Side effects of the substance can manifest themselves in the form of dizziness and increased intracranial pressure, bronchospasm and tachycardia, vomiting and nausea. Morphine should be given especially carefully to children under 2 years of age. Since they are more sensitive, the effects of the drug sometimes cause unpredictable reactions.

Signs of morphinism - addictions

As is often the case, the drug attracted the attention of drug addicts, because it improves mood, causes mild euphoria, and begins to act within 10 minutes. Moreover, this state can last up to 8 hours.

Identifying a morphine addict is very simple. It will always be issued:

• Watery eyes with a reddish tinge and constricted pupils.
• Scars (and if hygiene is not observed, abscesses) on the skin at the injection site.
• Relaxation, apathy, lethargy and drowsiness.
• Incorrect bowel function - diarrhea or constipation.
• Decrease in temperature. Quite often, chills in combination with goose bumps are replaced by fever.

Consequences of using morphine

Uncontrolled use of the drug can not lead to anything good. Such a person is more susceptible to various diseases of the lungs or heart, hepatitis, decreased immunity, and the development of encelopathy, which causes the death of brain cells. Withdrawal may begin 10-12 hours after the last dose of the drug. The withdrawal syndrome usually lasts up to 2 weeks.

The psychological dependence on morphine is terrible. Even if there is no physical need to use the substance, addicts still cannot cope with daily activities and think about the drug. That is why among such people the percentage of relapses is high (up to 96%). To get rid of psychological dependence, it is desirable to change the environment and determine the motivations for quitting drugs and healthy behavior.

Morphine (5a,6a) -didehydro-4,5-epoxy-17-methylmorphinan-3,6-diol)- one of the main alkaloids opium. The word comes from ancient Greek god Morpheus, literally one who produces dreams. old name - morphine. Contained in poppy sleeping pills, stephania, synomenium, moonseed. Less common in the genera Croton, cocculus, triclisia, okotea. Practically obtained only from the dried milky juice of the opium poppy. The content of morphine in raw opium reaches 10-20%, the minimum concentration is about 3%.
It must be said that the opium poppy contains only one stereoisomer, (-)-morphine. (+)-morphine was synthesized and does not have the pharmacological properties of (-)-morphine.

The chemical formula of morphine is C17H19NO3.

In its pure form, morphine is a white crystalline powder, which acquires a yellowish or grayish tint upon prolonged storage. It is mainly produced in the form of a solution for injection.

Medical use of morphine wide enough. Morphine derivatives, in particular, hydrochloride (for injection) and sulfate (as an oral drug) as an analgesic (analgesic, mild anesthetic, sedative) drug. Morphine is able to effectively suppress the feeling of strong physical pain and psychogenic pain. It also has sedative activity, suppresses the cough reflex. Lowering the excitability of pain centers, it also has an anti-shock effect in case of injuries. Used in acute myocardial infarction.
Morphine is sometimes used in radiological practice in the study of the stomach, duodenum, gallbladder. The introduction of morphine increases the tone of the muscles of the stomach, increases its peristalsis, accelerates its emptying and causes stretching of the duodenum. contrast agent. This helps to identify ulcers and tumors of the stomach, duodenal ulcers. The contraction of the sphincter of Oddi muscle caused by morphine creates favorable conditions for x-ray examination of the gallbladder.

Since morphine has a narcotic effect on the human body, drug addicts have not bypassed it either. The action of the drug begins 5-10 minutes after intravenous or intramuscular injection. The peak concentration of morphine in the blood is observed after 20 minutes. The effect of the drug on the human body is accompanied by euphoria, a feeling of warmth, drowsiness and a decrease in the level of consciousness. Depending on the dosage, the effect of morphine can last from 2 to 8 hours.

Signs of morphine use:
Great constriction of pupils, eyes slightly reddish and very shiny; bruising under the eyes, superficial intermittent slow breathing; skin itching (especially the nose); lethargic and sleepy; slurred speech; passivity and general relaxation; apathy towards everything but oneself; euphoria and carelessness; excessive "courage" and determination; nervousness; dry skin and mucous membranes (lips, tongue); superficial sleep; decrease in urine output; frequent constipation; with a cold, there is no cough; slight decrease in body temperature. Characteristic of the action of morphine is the inhibition of the respiratory center. Toxic doses cause the appearance of periodic breathing and subsequent death, as a result of respiratory arrest.

Consequences of using Morphine:
Morphine is a strong narcotic drug and quickly becomes addictive, and as a result, a persistent physical dependence develops. This is due to the fact that some parts of the morphine molecules are very similar to fragments of endorphins. In normal life, endorphins are produced nervous system and regulate the emotional and intellectual activity of a person. Already after 2-3 weeks of regular use of the drug, a person is practically unable to get rid of addiction on his own. Tolerance to the drug develops fairly quickly., and a constant increase in dose can lead to overdose and death. Withdrawal syndrome occurs 10-12 hours after the last dose of morphine. It manifests itself in the form of irritability, aggression, muscle breakdown, nausea and vomiting. The period of acute withdrawal syndrome is 5-14 days. In addition, morphine causes side effects associated with a decrease motor ability intestines (constipation).

From Morfin's story:
Morphine was first isolated by the German pharmacologist Friedrich Sertuner from opium in 1804 year. It was F. Sertuner who gave morphine its name after the god of dreams in Greek mythology - Morpheus, the son of Hypnos, the god of sleep.

Tom de Quincey left an essay "Confessions of an English Opioman" ( 1822 ), in which he described in detail how morphine drug addiction develops. Morphine was the first alkaloid to be purified.. However, morphine gained popularity after the invention of the injection needle in 1853 year. It has been used to relieve pain. In addition, it was used as a "treatment" for opium and alcohol addiction. The widespread use of morphine during the American Civil War led to the emergence of "army disease" (morphine addiction) in more than 400,000 people.

V 1874 morphine was synthesized from morphine diacetylmorphine, better known as heroin. Prior to the synthesis of heroin, morphine was the most widely used narcotic analgesic in the world.

V late XIX century, German soldiers and officers returning from the Franco-Prussian war of 1870-1871 turned out to be morphine addicts in almost half of the cases. Many soldiers in combat conditions injected themselves with morphine, which at that time became an affordable and fashionable sedative. In 1879, in one of the works, a description of the disease appeared, which was called "soldier's". At that time, almost any disease in the American army was treated with opium. In 1880, on international conference, it was announced the emergence of a new disease "addiction", caused by the abuse of narcotic substances.

In the early twentieth century, many doctors became morphine addicts. There was an opinion in the medical environment that a doctor who understood the perniciousness of morphinism was able, if necessary, to independently apply morphine for himself, avoiding addiction due to awareness. Practice has shown that this opinion was erroneous.

Complete synthesis of morphine was carried out only in 1952, but its length and complexity (originally 17 stages were included) makes it impractical to commercialize it. Several different synthesis methods have now been proposed, but natural morphine is still cheaper than synthetic morphine.

At the beginning of the 20th century, many doctors became morphine addicts. There was an opinion in the medical environment that a doctor who understood the perniciousness of morphinism was able, if necessary, to independently apply morphine for himself, avoiding addiction due to awareness. Practice has shown that this opinion was erroneous. Mikhail Bulgakov, the author of the story "Morphine", was a morphine addict for some time, but he was completely cured of drug addiction thanks to the selfless help of his first wife. Leo Tolstoy, in Anna Karenina, describes how the main character became addicted to morphine after it was first administered to her to relieve the pain of her second childbirth. A famous morphine addict was Hermann Goering, however, he was cured of this addiction. A lot of creative people have fallen into the trap of morphinism. So, Edith Piaf at the end of her life was forced to resort to injections even during her performances. Among the victims of morphine can be attributed to Vladimir Vysotsky.

The need for analgesics arises in all areas of medicine. But the problem of anesthesia is especially acute in oncology. When the possibilities of traditional analgesics have been exhausted, one has to resort to narcotic drugs. The strongest of them is morphine and its derivatives.

What is morphine and where is it used? What dosage forms does it come in? What effect does it have on a person? Are there any restrictions in its use? What should be done in case of poisoning and overdose? Is there an antidote for morphine? Below we will answer all these questions.

Description of morphine

Morphine has been known to people since 1804, when it was first isolated from opium by the German pharmacologist Friedrich Serturner. The scientist named this substance in honor of the Greek god of dreams, Morpheus, because in large doses it caused a hypnotic effect. But the drug began to be widely used only 50 years later, when the injection needle was invented. Morphine has been used since its discovery to the present to relieve pain.

Morphine (Morphinum) is an opioid analgesic (the main alkaloid of opium) - medicinal product used in medicine as a strong pain reliever.

What is morphine made from? - the alkaloid of this substance is extracted exclusively from the frozen milky juice (opium), which is released during the incision of immature opium poppy heads. The content of morphine with opium ranges from 10 to 20%. A natural source of the alkaloid is also plants from the poppy family - moonseed, okotea. But they contain alkaloid in smaller quantities. The industry also uses threshed straw and oil poppy heads.

Attention! In relation to morphine, there is a legal restriction for use. It belongs to list II of the list of narcotic drugs, psychotropic drugs and their precursors, the circulation of which is subject to control in Russia.

Pharmacological properties

Morphine belongs to the pharmacological group "Analgesic drugs". It has a selective ability to suppress the feeling of pain through its influence on the central nervous system.

How does morphine work?

1. Violates the transmission of sensitive and pain impulses through neurons by activating the endogenous antinociceptive system.
2. Changes perception pain sensation, acting on the centers of the brain.

Morphine acts as a stimulant of opioid receptors, which are located in the myocardium, vagus nerve, in the nerve plexus of the stomach. But the highest density of receptors is found in the gray matter of the brain and spinal ganglia. Activation of alkaloid receptors leads to a change in the metabolism of these organs at the biochemical level.

Action of morphine

The effect of morphine on the human body is as follows.

After absorption into the blood, 90% of morphine is broken down in the liver. Only 10% is excreted by the kidneys unchanged. After subcutaneous administration of the drug, its action begins after 15, and after internal administration - 20-30 minutes and lasts 4-5 hours.

Indications

Indications for the use of morphine in medicine are due to its analgesic effect.

What is morphine used for?

1. To relieve pain in case of injury, thereby preventing the development of shock.
2. Application for myocardial infarction relieves pain and prevents cardiogenic shock, which threatens the life of the patient.
3. The most common use of morphine is in cancer patients with unbearable pain that is not amenable to other drugs.
4. With a severe attack of angina pectoris.
5. It is used in the period of preparation for surgery, as well as pain relief after surgery.

And also it is used as an additional remedy for epidural and spinal anesthesia.

Side effects

Morphine has a toxic effect on all organs. Main side effects, the following.

expressiveness side effects depends on the dose and duration of use.

Contraindications

An absolute contraindication is hypersensitivity to opiates.

Morphine is contraindicated for:

• kidney failure;
• abdominal pain of unknown etiology;
• traumatic brain injury;
• epilepsy attack;
• increased intracranial pressure;
• coma;
• children's age up to 2 years.

Morphine is contraindicated for labor pain relief because it can cause respiratory depression.

Given the negative impact of the alkaloid on many systems and organs, its use is limited in people with chronic diseases.

Use morphine with caution in the following patients.

1. COPD (chronic obstructive pulmonary disease), including bronchial asthma.
2. Surgical interventions on the organs of the digestive system, including those with cholelithiasis.
3. Operations on the urinary organs.
4. Inflammatory bowel disease.
5. Urinary canal strictures.
6. Alcoholism.
7. Hyperplasia of the prostate.
8. Suicidal tendencies.
9. emotional lability.

In asthenic condition, as well as in elderly patients and in childhood, the potential harm is commensurate with the expected benefit. Morphine is not used together with other narcotic analgesics. During the period of treatment, care should be taken when driving transport or work that requires concentration.

Use in cancer patients

The Ministry of Health of Russia issued Order No. 128 dated July 31, 1991 on pain therapy rooms, hospices and departments of symptomatic care for cancer patients. At an early stage of cancer development, light narcotic drugs are used.

Morphine in oncology is used in patients in the third stage of the disease with unbearable pain.

Medicinal substances that are used in oncology:

• "Morphine hydrochloride";
• "Morphine sulfate";
• "Morphine".

The dosage and dosage form of these substances for oncological patients is determined by the doctor. The patient must follow the rules of admission by the hour, and not on demand. When calculating the initial minimum dose is increased to the analgesic effect. For parenteral use, the drug is administered subcutaneously. Intramuscular use is not recommended because it is unevenly absorbed. The drug is also administered transdermally (in a patch), orally in tablets and capsules.

Preparations

In medicine, alkaloid derivatives are used - morphine hydrochloride and sulfate. Most commonly used for subcutaneous injection. For each patient, the doctor selects an individual dose depending on the clinical symptoms. Adults use 1% ml (10 mg) subcutaneously with a frequency of 2 times in 12 hours. The maximum effect is reached after 2 hours and lasts 10-12 hours. The maximum single dose is 2 ml (20 mg), and the daily dose is 5 ml (50 mg). For children over 2 years of age, a single dose of 1–5 mg. Morphine sulfate and hydrochloride is available in ampoules of 1% solution for subcutaneous use.

Preparations containing this alkaloid are available in various dosage forms - granules for the preparation of a solution, capsules and tablets of prolonged action, injections and rectal suppositories.

"Omnopon" (medical opium) is a combined narcotic analgesic. It is produced only in the form of a solution for subcutaneous administration. It contains: narcotine, papaverine, codeine, thebaine and morphine. "Omnopon" has not only a strong analgesic, but also an antispasmodic effect.

There are also synthetic drugs that replace morphine, which differ from it in chemical structure, but are similar to it in pharmacological action.

All drugs are issued strictly by prescription, as drug addicts abuse morphine and its derivatives.

Morphine poisoning

Morphine poisoning in the home or in a medical setting can occur accidentally or intentionally with the intent to commit suicide. In adults, it occurs after ingestion of more than 0.1 grams and does not depend on the dosage form and route of administration. The alkaloid causes poisoning after administration of this dose in a suppository through the rectum, ingestion, or injection into a vein and under the skin. After addiction, the toxic dose increases. The clinical picture of poisoning resembles an alcoholic coma.

pupillary constriction

Signs of poisoning are as follows.

1. At the beginning of intoxication, euphoria, anxiety, dry mouth appear.
2. With an increase in symptoms, headache intensifies, nausea, vomiting with the urge to urinate frequently.
3. Further, drowsiness increases. The patient falls into a stupor, which turns into a coma.
4. A significant symptom is a sharp narrowing of the pupils.
5. The leading symptom of morphine poisoning is respiratory failure, which sharply slows down to 1–5 times per minute.
6. If the morphine antidote is not administered on time, fatal outcome occurs due to paralysis of the respiratory center.

An overdose of morphine is accompanied by loss of consciousness. In a severe case, oppressed breathing is observed, blood pressure decreases, and body temperature drops. A hallmark of an overdose of the drug is constricted pupils. However, with severe hypoxia due to respiratory depression, the pupils can, on the contrary, be greatly dilated.

The lethal dose of morphine when taken orally is 0.5-1 grams, and when administered intravenously - 0.2. But with morphinism, it increases to 3-4 grams due to addiction.

First aid for poisoning with a drug taken orally is to wash the stomach with a solution of potassium permanganate. After taking any sorbent. In addition, the patient needs to be warmed. If after these measures, the symptoms do not decrease, the patient is subject to hospitalization.

In case of morphine poisoning, the antidote is Naloxone and Nalorfin. They are administered intravenously 1-2 ml of solution. Help for the patient consists in artificial ventilation of the lungs and intravenous administration of any morphine antagonist - "Naloxone" or "Nalorphine". They eliminate euphoria, dizziness, restore breathing. The introduction of drugs is repeated until the symptoms of overdose disappear. The hospital also does catheterization Bladder due to spasm of the urinary tract.

Morphinism

As a result of the frequent use of a narcotic drug as an anesthetic for somatic diseases, morphinism develops - an addiction. When used, the drug improves mood, causes euphoria. This is the reason why it needs to be reused.

It is known that during civil war in the United States, addiction to this painkiller turned into an army disease that affected about 400,000 soldiers. And at the end of the 19th century, half of the German soldiers who returned from the Franco-Prussian war were drug addicts.

Habituation develops quickly, which requires an increase in dose. People who are addicted to morphine cannot do without it - if they stop taking it, it develops withdrawal syndrome. This condition is expressed by increased breathing and heart rate, decreased pressure, diarrhea, dry cough. To get a dose, drug addicts resort to all available and inaccessible methods, often commit crimes.

Analyzing the above, we recall that the alkaloid morphine is extracted from natural raw materials - opium and other varieties of poppies. In medicine, morphine derivatives of varying intensity and duration of analgesic action are used. There is a risk of side effects and overdose. Long-term use leads to addiction, so the circulation of the substance is regulated by law - morphine belongs to the list II of the list of narcotic drugs subject to control in Russia.

1 ml of solution contains 10 mg of the active substance according to INN - morphine hydrochloride .

1 capsule of prolonged action contains 10 mg of Morphine.
Morphine formula: C17-H19-N-O3.

Release form

The solution is available in 1 ml ampoules. The carton pack contains 1 blister pack (for 5 ampoules) and instructions from the manufacturer.

Prolonged capsules are available in packs of cardboard (10 pieces per pack).

pharmachologic effect

What is Morphine?

Morphine is opioid pain reliever , drug . According to the mechanism of action, the drug belongs to opioid receptor agonists. The drug has antishock effect , reduces the excitability of pain centers. The hypnotic effect is manifested when prescribing high dosages.

The active substance increases the tone of the sphincters, smooth muscle muscles of the bronchi and internal organs, reduces the excitability of the cough center, inhibits conditioned reflexes, causes bradycardia . The drug tones the sphincters of the bladder, biliary tract; depresses the respiratory center, lowers body temperature, slows down metabolism, inhibits the secretory activity of the digestive system, stimulates the production of ADH.

Effect on the brain

Excitation of trigger chemoreceptor zones in the medulla oblongata leads to activation of the gag reflex. After subcutaneous injection, the drug begins its action after 10-15 minutes. The effective action of prolonged capsules is recorded after 20-30 minutes.

Pharmacodynamics and pharmacokinetics

After subcutaneous administration and oral administration of capsules, the drug is rapidly absorbed and enters the systemic circulation. When taken orally, the absorption rate reaches 80%. For the drug, the nature of the effect is "first pass" through the hepatic system. Due to conjugation with glucuronides, it is fully-fledged in the liver.

The half-life is 2-3 hours. The main route of excretion of metabolites is through the renal system (90%). A small part (about 10%) is derived from. Elderly patients are characterized by an increase in T1 / 2 (similarly in the pathology of the renal system and liver).

Indications for use

Morphine - what is it? This is a narcotic analgesic prescribed for the relief of severe pain in:

• traumatic injuries;
• malignant neoplasms;
• surgical interventions;

The drug can be prescribed for severe shortness of breath, provoked by insufficiency of cardio-vascular system; with a cough that cannot be stopped with antitussive medicines.

Contraindications

• traumatic brain injury;
• respiratory failure due to depression of the respiratory center;
• severe general exhaustion of the body;
• severe pain in the epigastric region of unknown origin;
• delirium;
• epistatus;
• hepatocellular insufficiency;
• treatment with MAO inhibitors;
• age limit - up to 2 years.

Side effects

Urinary tract:

Violation of the urine flow with urethral stenosis,.

The cardiovascular system:

Rare pulse, bradycardia.

Digestive tract:

• cholestasis of the main bile duct;
• vomit;
• nausea;

Nervous system:

• increased intracranial pressure with a high risk of development;
• exciting effect;
• sedative effect;
• development ;
• delirium.

Morphine, instructions for use (Method and dosage)

Instructions for use Morphine hydrochloride

Individual dosing regimen. Subcutaneously injected once 1 mg. Further selection of the dose is carried out on the basis of the severity of the pain syndrome.

Taking capsules

Every 12 hours, 10-100 mg, depending on the desired therapeutic effect. For children from 2 years old, a single dosage is 1-5 mg.

Overdose

Poisoning is manifested by a peculiar clinical picture (acute and chronic overdose):

• clammy, cold sweat;
• fatigue;
• the fall ;
• confusion;
• difficult, slow breathing;
• bradycardia;
• miosis;
• expressed;
• bradycardia;
• delirious psychosis;
• dry mouth;
• anxiety;
• intracranial hypertension;
• stop breathing;
• muscle rigidity;
• coma.

Treatment

A specific antagonist is urgently injected intravenously - at a dose of 0.2-0.4 mg. After 2-3 minutes, the injection is repeated until the total amount of the administered medication is 10 mg.

In pediatrics, the initial dosage of Naloxone is 0.01 mg / kg. Measures are being taken to stabilize blood pressure, restore the functioning of the respiratory system, and the heart.

Interaction

Enhances the sedative, hypnotic effect of anxiolytics and anesthesia (general, local). The simultaneous administration of narcotic painkillers and barbiturates can lead to a pronounced suppression of the active brain, the development arterial hypotension , respiratory depression.

The effect of opioid analgesics is reduced with the systematic use of other barbiturates (cross-tolerance is typical). Therapy with MAO inhibitors can adversely affect the functioning of the cardiovascular system. Possible development myoclonus in cancer patients during treatment.

Clinical treatment of alcoholism

This drug was first developed in early XIX centuries. The synthesis was carried out by a German chemist. Although the origin itself was at the beginning of this century, the popularity of morphine came in the middle of the century by 1857. This happened when a syringe was first developed, with which this agent was introduced into the body. The scientist from Germany, who discovered morphine, considered it a wonderful sleeping pill. That is why the substance was named after the god Morpheus. The presented remedy could easily replace opium, so it was widely used in the treatment of opiomania. The beneficial effect of the use led to the fact that the negative aspects of this drug were not immediately identified. It should be noted that the creator of this drug himself suffered from its negative impact. Only at the end of his life did he realize that morphine was the cause of his malaise. By 1874, it was found that addiction to this substance is even stronger than to opium, which is why the term "morphinism" appeared, meaning dependence on this drug. In addition, it should be noted that dependence on the psychological level occurs much faster than physical cravings.

Indications

Features of the treatment of alcohol addiction

When it comes to morphine, it cannot be unequivocally said that it is useful or dangerous. This remedy is still widely used for medical purposes. Morphine is available in the form of tablets, ampoules or syringes-tubes. The injection format is the most common. The drug can be administered in various ways. Which method to use in a particular case is decided by the doctor.

• There is severe pain that may be present in patients due to trauma, cancer, and heart attack.
• When there is severe shortness of breath or cough caused by heart failure.
• When a person is prepared for an operation or helps to recover after its implementation.
• In case of insomnia, especially if it is provoked by pain.
• When X-ray diagnostics of the intestine is performed in order to identify tumors and ulcers.