Morphine

Why is this medicine prescribed?

Morphine is used to relieve severe pain.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.

Are there other uses for this medicine?

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Morphine comes as a solution (liquid), an immediate-release tablet, an extended-release (long-acting) tablet, and as an extended-release (long-acting) capsule to take by mouth. Take the oral solution and immediate-release tablets every 4 hours as needed for pain.Take the extended-release tablets every 8 or every 12 hours. Take the extended-release capsules with or without food every 24 hours. Take morphine at the same times every day.

Use the dosing cup or syringe to measure your dose of morphine solution. Ask your pharmacist if you have any question about how much medication you should take or how to use the dosing cup or syringe.

If you are taking extended-release capsules and you have a gastrostomy tube (surgically inserted feeding tube), ask your doctor or pharmacist how to administer the medication through your tube.

If you are unable to swallow the extended-release capsules, carefully open a capsule, sprinkle all of the beads on a spoonful of cold or room temperature applesauce. Swallow the entire mixture immediately without chewing or crushing the beads. Then rinse your mouth with a little water and swallow the water. Do not mix the beads into any other food. Do not save mixtures of medication and applesauce for later.

Your doctor may adjust your dose of morphine during your treatment, depending on how well your pain is controlled and on the side effects that you experience. Talk to your doctor about how you are feeling during your treatment with morphine. Tell your doctor if you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain during your treatment with morphine. Do not take more of it or take it more often than prescribed by your doctor.

Talk to your doctor or pharmacist about access to rescue medicines, naloxone or nalmefene,while taking morphine. Rescue medications can reverse the life-threatening effects of anopioid overdose and are available over the counter or with a prescription. Make sure that youand your family members and people usually around you know how to recognize an overdose,how to use naloxone or nalmefene, and what to do until emergency medical help arrives. Yourdoctor or pharmacist will show you and others how to use it. If symptoms of an overdose occur,they should give the first dose of naloxone, call 911 immediately, and stay with you and watchyou closely until emergency medical help arrives. If your symptoms return, the person shouldgive you another dose of the rescue medication. Additional doses may be given every 2 to 3minutes, if symptoms return before medical help arrives.

If you have been taking morphine regularly, do not stop taking morphine without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop taking morphine, you may experience withdrawal symptoms such as restlessness; teary eyes; runny nose; yawning; irritability; anxiety; sweating; difficulty falling asleep or staying asleep; chills; back, muscle, or joint pain; nausea; vomiting; loss of appetite; diarrhea; stomach cramps; weakness; fast heartbeat; or fast breathing. Your doctor will probably decrease your dose gradually.

What special precautions should I follow?

Before taking morphine,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any otherdrugs, foods or substances. Tell your doctor or pharmacist about the allergy and whatsymptoms you had.

• some medications should not be taken with morphine. Make sure you have discussed anymedications you are currently taking or plan to take before starting morphine with your doctorand pharmacist. Before starting, stopping, or changing any medications while takingmorphine, please get the advice of your doctor or pharmacist.

• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, or tranylcypromine.

• the following nonprescription or herbal products may interact with morphine: St. John's wortand tryptophan. Be sure to let your doctor and pharmacist know that you are taking thesemedications before you start taking morphine. Do not start these medications while takingmorphine without discussing it with your healthcare provider.

• tell your doctor if you have or have ever had slowed breathing, asthma, chronic pulmonary disease (COPD), or other lung problems, a blockage or narrowing of your stomach or intestines, or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take morphine.

• tell your doctor if you have or have ever had a head injury, a brain tumor, or any conditionthat increases pressure in the brain; seizures; or heart, kidney, liver, pancreas, thyroid,or gall bladder disease.

• tell your doctor if you are breastfeeding. You should not breastfeed while you are taking morphine.

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

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

• you should know to not drink alcoholic beverages while you are taking morphine. Alcohol can make the side effects from morphine worse.

• you should know that morphine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

• you should know that morphine may cause constipation.Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are taking morphine.

What special dietary instructions should I follow?

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

What should I do if I forget to take a dose?

If you are taking morphine on a regular schedule, take the missed dose as soon as youremember it.However, if it is almost time for the next dose, skip the missed dose and continueyour regular dosing schedule.Do not take a double dose to make up for a missed one.Do nottake more than one dose of the extended-release capsules in 24 hours.

What side effects can this medicine cause?

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

• nausea, vomiting, gas
• sweating
• headache
• decreased sexual desire, inability to get or keep an erection
• weakness, tiredness

Some side effects can be serious. If you experience any of the following symptoms or those in the IMPORTANT WARNING section, call your doctor immediately:

• chest pain, 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, or diarrhea
• nausea, vomiting, loss of appetite, weakness, or dizziness
• new pain or pain from touch or doing ordinary tasks such as combing your hair
• difficulty swallowing, regurgitation (bringing up swallowed food into throat andmouth), pain in the chest area
• seizures
• extreme drowsiness
• hives; rash; itching; swelling of the eyes, face, mouth, lips or throat; hoarseness; difficulty breathing or swallowing
• unusual snoring or long pauses during breaths during sleep

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 (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children, and in a location that is not easily accessible by others, including visitors to the home. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Store morphine products in a safe place so that no one else can take it accidentally or onpurpose. Keep track of how many tablets or solution is left so you will know if any are missing.

Dispose of any medication that is outdated or no longer needed through a medicine take-back program. If you do not have a take-back program nearby or one that you can access promptly, flush any morphine extended-release tablets, extended-release capsules, and liquid that are outdated or no longer needed down the toilet so that others will not take them. Talk to your pharmacist about the proper disposal of your medication.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• slow, shallow, or irregular breathing
• difficulty breathing
• excessive sleepiness
• unable to respond or wake up
• limp or weak muscles
• cold, clammy skin
• narrowing or widening of the pupils (dark circle in the eye)
• slow heartbeat

What other information should I know?

Keep all appointments with your doctor.

Before having any laboratory test, 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.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.

Brand name(s)

• Arymo^® ER¶
• Avinza^®¶
• Kadian^®¶
• Morphabond^®¶
• MS Contin^®
• Oramorph^® SR¶
• Embeda^® (as a combination product containing Morphine, Naltrexone)¶
• also available generically