MS Contin

Morphine



(mor' feen)

Arymo® ER
Avinza®¶
Kadian®
Morphabond®
MS Contin®
Oramorph® SR¶
Roxanol-T¶
Embeda® (as a combination product containing Morphine, Naltrexone)¶

Morphine may cause serious or life-threatening breathing problems, especially during the first 24 to 72 hours of your treatment and any time your dose is increased. Your doctor will monitor you carefully during your treatment. Your doctor will adjust your dose carefully to control your pain and decrease the risk that you will experience serious breathing problems. Tell your doctor if you have or have ever had slowed breathing or asthma. Your doctor may tell you not to take morphine. Also tell your doctor if you have or have ever had lung disease such as chronic obstructive pulmonary disease (COPD; a group of lung diseases that includes chronic bronchitis and emphysema), a head injury, or any condition that increases the amount of pressure in your brain. The risk that you will develop breathing problems may be higher if you are an older adult or are weakened or malnourished due to disease. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: slowed breathing, long pauses between breaths, or shortness of breath.
Taking certain other medications during your treatment with morphine may increase the risk that you will experience breathing problems or other serious, life-threatening breathing problems, sedation, or coma. Tell your doctor if you are taking or plan to take any of the following medications: benzodiazepines such as alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), and triazolam (Halcion); cimetidine (Tagamet); other narcotic pain medications; medications for mental illness or nausea; muscle relaxants; sedatives; sleeping pills; or tranquilizers. Your doctor may need to change the dosages of your medications and will monitor you carefully. If you take morphine with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.
Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with morphine increases the risk that you will experience breathing problems or other serious, life-threatening side effects. If you are taking Avinza brand long-acting capsules, it is especially important that you do not drink any drinks that contain alcohol or take any prescription or nonprescription medications that contain alcohol. Alcohol may cause the morphine in Avinza® brand long-acting capsules to be released in your body too quickly, causing serious health problems or death. Do not drink alcohol, take any prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment with other morphine products.
Morphine may be habit-forming. Do not take more of it, take it more often, or take it in a different way than directed by your doctor. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse morphine if you have or have ever had any of these conditions.
Do not allow anyone else to take your medication. Morphine may harm or cause death to other people who take your medication, especially children. Keep morphine in a safe place so that no one else can take it accidentally or on purpose. Be especially careful to keep morphine out of the reach of children. Keep track of how many tablets, or capsules, or how much liquid is left so you will know if any medication is missing. Dispose of any unneeded morphine capsules, tablets, or liquid properly according to instructions. (See STORAGE and DISPOSAL.)
Swallow the extended-release tablets or capsules whole. Do not split, chew, dissolve, or crush them. If you swallow broken, chewed, crushed, or dissolved extended-release tablets or capsules, you may receive too much morphine at once instead of receiving the medication slowly over time. This may cause serious breathing problems or death. If you are unable to swallow the capsules whole, follow the instructions in the ''HOW should this medication be used?'' section below to dissolve the capsule contents in applesauce.
Morphine oral solution (liquid) comes in three different concentrations (amount of medication contained in a given amount of solution). The solution with the highest concentration (100 mg/5 mL) should only be taken by people who are tolerant (used to the effects of the medication) to opioid medications. Each time you receive your medication, check to be sure that you receive the solution with the concentration prescribed by your doctor. Be sure that you know how much medication you should take and how to measure your dose.
Tell your doctor if you are pregnant or plan to become pregnant. If you take morphine regularly during your pregnancy, your baby may experience life-threatening withdrawal symptoms after birth. Tell your baby's doctor right away if your baby experiences any of the following symptoms: irritability, hyperactivity, abnormal sleep, high-pitched cry, uncontrollable shaking of a part of the body, vomiting, diarrhea, or failure to gain weight.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with morphine and each time you fill your prescription if a Medication Guide is available for the morphine product you are taking. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (http://www.fda.gov/Drugs/DrugSafety/ucm085729.htm) or the manufacturer's website to obtain the Medication Guide.

Morphine is used to relieve moderate to severe pain. Morphine extended-release tablets and capsules are only used to relieve severe (around-the-clock) pain that cannot be controlled by the use of other pain medications. Morphine extended-release tablets and capsules should not be used to treat pain that can be controlled by medication that is taken as needed. Morphine is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

Morphine rectal comes as a suppository to insert in the rectum. It is usually inserted every 4 hours. Use rectal morphine at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use morphine exactly as directed.
Your doctor may adjust your dose of morphine during your treatment to control your pain as well as possible. If you feel that your pain is not controlled, call your doctor. Do not change the dose of your medication without talking to your doctor.
Do not stop using morphine without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop using morphine, you may experience withdrawal symptoms such as anxiety; sweating; difficulty falling asleep or staying asleep; chills; shaking of a part of your body that you cannot control; nausea; diarrhea; runny nose, sneezing or coughing; hair on your skin standing on end; or hallucinating (seeing things or hearing voices that do not exist).
To use the suppositories, follow these steps:



Remove the wrapper.

Dip the tip of the suppository in water.

Lie down on your left side and raise your right knee to your chest (a left-handed person should lie on the right side and raise the left knee.)

Using your finger, insert the suppository about 1 inch (2.5 centimeters) into the rectum.

Hold it in place with your finger for a few moments

Stand up after about 15 minutes. Wash your hands thoroughly and resume normal activities.

Before using rectal morphine,

tell your doctor and pharmacist if you are allergic to morphine, any other medications, or any of the ingredients in morphine suppositories. Ask your pharmacist for a list of the ingredients.

do not use rectal morphine if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), procarbazine (Matulane), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) or if you have stopped taking any of these medications within the past 2 weeks. Your doctor will probably tell you not to use rectal morphine if you are taking one or more of these medications.

tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); antihistamines (found in cold and allergy medications); medications for seizures; barbiturates such as phenobarbital and primidone (Mysoline); beta-blockers such as propranolol (Hemangeol, Inderal, Innopran); butorphanol; chloral hydrate, chlorpromazine, dextromethorphan (found in many cough medications; in Nuedexta); lithium (Lithobid), medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); methocarbamol (Robaxin), mirtazapine (Remeron); nalbuphine; pentazocine (Talwin); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); tramadol (Conzip, Ultram, in Ultracet), and tricyclic antidepressants ('mood elevators') such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Many other medications may also interact with rectal morphine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan.

tell your doctor if you drink or have ever drunk large amounts of alcohol or have had biliary tract or stomach surgery. Also tell your doctor if you have or have ever had a head injury; a brain tumor or any condition that increases the amount of pressure in your brain; seizures; serious or life-threatening breathing problems; asthma; an irregular heartbeat; or heart failure. Your doctor will probably tell you not to use rectal morphine.

tell your doctor if you have ever had major surgery. Also tell your doctor if you have or have ever had mental illness; chronic obstructive pulmonary disease (COPD; a group of diseases that cause gradual loss of lung function) or other breathing problems; prostatic hypertrophy (enlargement of a male reproductive gland); urethral stricture (blockage of the tube that allows urine to leave the body); urinary problems; low blood pressure; Addison's disease (condition in which the body does not make enough of certain natural substances); or thyroid, liver, kidney, pancreatic, intestinal, or gallbladder disease.

tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using morphine, call your doctor.

you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using rectal morphine.

if you are having surgery, including dental surgery, tell the doctor or dentist that you are using morphine.

you should know that morphine may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

Unless your doctor tells you otherwise, continue your normal diet.

If you are taking morphine tablets or liquid, your doctor will probably tell you to take the medication as needed.
If you have been told to take scheduled doses of the tablets or liquid or if you are taking an extended-release product, take the missed dose as soon as you remember it, and do not take the next dose at your regularly scheduled time. Instead, allow the same amount of time that you usually allow between doses before taking your next dose. If you remember when it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Morphine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:



drowsiness

stomach pain and cramps

dry mouth

headache

nervousness

mood changes

small pupils (black circles in the middle of the eyes

difficulty urinating or pain when urinating

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:



blue or purple color to the skin

changes in heartbeat

agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea

nausea, vomiting, loss of appetite, weakness, or dizziness

inability to get or keep an erection

irregular menstruation

decreased sexual desire

seizures

extreme drowsiness

fainting

chest pain

fever

hives

rash

itching

swelling of the eyes, face, mouth, lips or throat

hoarseness

difficulty breathing or swallowing
Morphine may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them.  However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community.  See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

Keep all appointments with your doctor and laboratory. Your doctor may order certain lab tests to check your body's response to morphine.
Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking morphine.
This prescription is not refillable. If you are taking morphine to control your pain on a long term basis, be sure to schedule appointments with your doctor so that you do not run out of medication. If you are taking morphine on a short-term basis, call your doctor if you continue to experience pain after you finish the medication.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
¶ This branded product is no longer on the market. Generic alternatives may be available.