MORPHINE SULPHATE WARNINGS
Morphine sulphate should be used with caution in:
- People with decreased function of thyroid gland (hypothyroidism)
- People with decreased function of adrenal gland
- People with decreased kidney function
- People with decreased liver function
- People with decreased lung function and breathing difficulties
- People with severe cor pulmonale (a heart problem resulting from long-term lung disease)
- People with obstructive bowel disorders or myasthenia gravis (a condition with weakness of the muscles)
- People with low blood pressure
- People with an addiction, or history of, drug abuse
- People with an history of alcohol abuse
Morphine sulphate given by injection should not be used in the following, but given in caution with morphine sulphate given orally.
- People with inflammatory bowel disease, such as Crohn's disease and ulcerative colitis
- People with low blood pressure with low blood volume (hypovolaemia)
- People with gall-bladder dysfunction
- People with an inflamed pancreas (pancreatitis)
- People with convulsions (fits) e.g.. epilepsy
- People with inflammation of the prostate gland (prostatic hypertrophy /shock)
- People with a disorder due to thyroid deficiency (myxoedema)
It should not be used in:
- People with an allergy to morphine sulphate, or any of its ingredients
- People with severe breathing difficulties
- People during an attack of bronchial asthma
- People with obstructive airways disease
- People with head injuries
- People with increased intracranial pressure (increased pressure in the brain)
- People in a coma
- People with acute alcoholism
- People with kidney failure
- People with narrowing of the ureter (ureteral stenosis, making it difficult to pass urine)
- People with liver failure
- People with a paralytic ileus (inactivity of intestine which results delayed emptying and movement through the gut)
- People with a tumour of the adrenal gland (phaeochromocytoma )
- Pre-operatively or for the first 24 hours post-operatively
- People using monoamine oxidase inhibitors (MAOIs) or within two weeks of discontinuation of their use
- Children under one year of age
- Pregnant women
- Women breastfeeding
Also see list of precautions and interactions
Do not store above 25°C. Store in the original package in a dry place protected from heat.
MORPHINE SULPHATE USES
What is it used for?
- Morphine sulphate is used to relieve severe pain.
- It is a narcotic analgesic, sometimes known as an opioid painkiller.
- It is used to control and reduce severe pain.
- In general this drug is used to treat severe pain resulting from long term illnesses, such as cancer. It is also used to relieve severe pain after surgeries, such as caesarean sections.
- Benefits of being on this drug can include the effective control of severe pain.
Listed below are the typical uses of morphine sulphate.
- Pain resulting from long term illnesses
- Post-operative pain
On occasion your doctor may prescribe this medicine to treat a condition not on the above list.
HOW TO USE/TAKE
Take this medication orally or as an injection as directed by your doctor, with or without food.
Use this medication as directed by your doctor in order to get the most benefit from it.
Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
The length of time for maximum effect of this medication is dependent upon the form of the medication and how it has been taken. Some forms of this medication are 'modified release' which means they are gradually released into the body over a period of time, usually 12 hours.
Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- It is not recommended to drive or operate machinery. Please check information specific to the brand of morphine sulphate which you are using. Consult your doctor or pharmacist for more details.
When can I stop?
- If you are having problems with this medication please consult your doctor immediately. It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop. Abruptly stopping your medication may result in your symptoms worsening and you may experience withdrawal symptoms. If your medication is stopped, your doctor may gradually decrease the medication over a period of time.
MORPHINE SULPHATE SIDE EFFECTS
If any of these persist or you consider them severe then inform doctor or pharmacist.
Tell your doctor immediately if you develop any of the following symptoms:
- Tolerance or dependence on medication
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
MORPHINE SULPHATE PRECAUTIONS
Before taking morphine sulphate, tell your doctor or pharmacist if you are allergic to it; or to other analgesics or opioids; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have:
- Allergy to morphine sulphate, or any of its ingredients
- Severe breathing difficulties
- Attack of bronchial asthma
- Obstructive airways disease
- Head injury
- Increased intracranial pressure (increased pressure in the brain)
- Acute alcoholism
- Kidney failure
- Narrowing of the ureter (ureteral stenosis, making it difficult to pass urine)
- Liver failure
- A paralytic ileus (inactivity of intestine which results delayed emptying and movement through the gut)
- A tumour of the adrenal gland (phaeochromocytoma )
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following:
- Decreased function of thyroid gland (hypothyroidism)
- Decreased function of adrenal gland
- Decreased kidney function
- Decreased liver function
- Decreased lung function and breathing difficulties
- Severe cor pulmonale (heart problem resulting from long-term lung disease)
- Obstructive bowel disorders or myasthenia gravis (a condition with weakness of the muscles)
- Low blood pressure
- Addiction, or history of, drug abuse
- History of alcohol abuse
Morphine sulphate (in the form of morphine sulphate injection) should not be used in the following. This medication should be used in caution in with all other brands:
- Inflammatory bowel disease, such as Crohn's disease and ulcerative colitis
- Low blood pressure with low blood volume
- Gall-bladder dysfunction
- Pancreatitis (enlarged pancreas)
- Convulsions (fits) e.g.. epilepsy
- Inflammation of the prostate gland (prostatic hypertrophy /shock)
- Disorder due to thyroid deficiency (myxoedema)
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- Alcohol should not be taken when on this medication as they do interact.
The elderly: morphine sulphate be used with caution in the elderly as it may result in more side effects of the medication as it takes longer for the medication to leave the body in elderly patients.
Pregnancy and breastfeeding - please ensure you read the detailed information below
Morphine sulphate is not safe to take if you are, or are planning to become, pregnant. This medication should not be used in labour and delivery.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Morphine sulphate is not safe to take if you are breastfeeding
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
MORPHINE SULPHATE INTERACTIONS
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:
- Monoamine oxidase inhibitors (MAOIs) or within two weeks of discontinuation of their use
- Mixed agonist/antagonist opioid analgesics, such as pentazocine, nalbuphine, buprenorphine
If you are currently using any of these medications, tell your doctor or pharmacist before starting morphine sulphate.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Central Nervous System depressants such as:
- Phenothiazines (for schizophrenia)
- Tricyclic antidepressants (for depression)
- Tranquilisers, sedatives, hypnotics, anxiolytics (for sleeping troubles and anxiety)
- Antipsychotics (for psychosis)
- Muscle relaxants
- Mexillitine, esthmol (used to control heart rhythm)
- Anti-hypertensives ( to lower blood pressure)
- Anti-arrhythmics (to control heart rhythm)
- Antidepressants, such as pethidine
- Cimetidine (for stomach problems)
- Domperidone, metoclopramide (for nausea and vomiting)
- Ritonavir (for HIV infections)
- Rifampicin ( an antibiotic)
- Medicines that block the action of acetylcholine, such as anti-histamines, anti-emetics and anti-Parkinson's
- Oramorph has also been noted to interact with gabapentin and voriconzole)
This information does not contain all possible interactions. Therefore, before using morphine sulphate, tell your doctor or pharmacist of all the products you use.
MORPHINE SULPHATE OVERDOSE
Signs of overdose may include breathing difficulties, small (pin point) pupils, sleepiness and drowsiness which can progress to a stupor and coma, low blood pressure, muscle weakening, cold and clammy skin, slow heart beat. Failure to pump blood around the body and deepening coma may occur in more severe cases. Convulsions (fits) may occur in infants and children.
Crushing of morphine sulphate prolonged release tablets and ingestion of this medication could result in immediate medication release around the body which could result in a fatal overdose.
Patients should be treated symptomatically as required, with immediate attention given to breathing and respiratory problems.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of morphine sulphate or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
Please consult your doctor if you miss a dose, and follow advice given.