$Unique_ID{BRK03244} $Pretitle{} $Title{morphine} $Subject{sulfate MS Contin Purdue-Frederick MSIR RMS Upsher-Smith Roxanol Roxane SR Analgesic morphine narcotic analgesic central nervous system brain spinal cord moderate severe pain} $Volume{} $Log{} Copyright (C) 1993 Publications International, Ltd. morphine ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) morphine sulfate (various manufacturers) MS Contin (Purdue-Frederick) MSIR (Purdue-Frederick) RMS (Upsher-Smith) Roxanol (Roxane) Roxanol SR (Roxane) TYPE OF DRUG Analgesic INGREDIENT morphine DOSAGE FORMS Tablets (15 mg and 30 mg) Sustained-release tablets (30 mg and 60 mg) Oral solution (10 mg and 20 mg per 5-ml spoonful, with 10% alcohol; 20 mg per ml) Rectal suppositories (5 mg, 10 mg, and 20 mg) STORAGE Morphine tablets and oral solution should be stored at room temperature in tightly closed, light-resistant containers. The rectal suppositories should be stored in the refrigerator. USES Morphine is a narcotic analgesic that acts directly on the central nervous system (brain and spinal cord). It is used to relieve moderate to severe pain. TREATMENT In order to avoid stomach upset, you can take morphine with food or milk. This medication works most effectively if you take it at the onset of pain, rather than waiting until the pain becomes intense. The solution form of this medication can be mixed with fruit juices to improve the taste. Measure each dose carefully with a specially designed 5-ml measuring spoon or with the dropper provided. An ordinary kitchen teaspoon is not accurate enough. The sustained-release tablets should be swallowed whole. Chewing, crushing, or crumbling the tablets destroys their sustained-release activity and possibly increases the side effects. To use the suppository form of this medication, remove the foil wrapper and moisten the suppository with water (if the suppository is too soft to insert, refrigerate it for half an hour or run cold water over it before removing the wrapper). Lie on your left side with your right knee bent. Push the suppository into the rectum, pointed end first. Lie still for a few minutes. Try to avoid having a bowel movement for at least an hour (to give the medication time to be absorbed). If you are taking this drug on a regular schedule and you miss a dose, take the missed dose as soon as possible, unless it is almost time for your next dose. In that case, do not take the missed dose at all; just return to your regular dosing schedule. Do not double the next dose. SIDE EFFECTS Minor. Constipation, dizziness, drowsiness, dry mouth, false sense of well-being, flushing, light-headedness, loss of appetite, nausea, rash, or sweating. These side effects should disappear as your body adjusts to the medication. If you are constipated, increase the amount of fiber in your diet (fresh fruits and vegetables, salads, bran, and whole-grain breads), exercise, and drink more water (unless your doctor directs you to do otherwise). Chew sugarless gum or suck on ice chips to reduce mouth dryness. If you feel dizzy or light-headed, sit or lie down for a while; get up from a sitting or lying position slowly. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about anxiety, difficulty in breathing, excitation, fainting, fatigue, painful or difficult urination, palpitations, restlessness, sore throat and fever, tremors, or weakness. INTERACTIONS Morphine interacts with several other types of drugs: 1. Concurrent use of it with other central nervous system depressants (such as alcohol, antihistamines, barbiturates, benzodiazepine tranquilizers, muscle relaxants, and phenothiazine tranquilizers) or with tricyclic antidepressants can cause extreme drowsiness. 2. A monoamine oxidase (MAO) inhibitor taken within 14 days of this medication can lead to unpredictable and severe side effects. 3. The depressant effects of morphine can be dangerously increased by chloral hydrate, glutethimide, beta blockers, and furazolidone. 4. The combination of cimetidine and morphine can cause confusion, disorientation, and shortness of breath. BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially any of those listed above. WARNINGS * Tell your doctor about unusual or allergic reactions you have had to any medications, especially to morphine or to other narcotic analgesics (such as codeine, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, and propoxyphene). * Tell your doctor if you now have or if you have ever had acute abdominal conditions, asthma, brain disease, colitis, epilepsy, gallstones or gallbladder disease, head injuries, heart disease, kidney disease, liver disease, lung disease, mental illness, emotional disorders, enlarged prostate gland, thyroid disease, or urethral stricture. * If this drug makes you dizzy or drowsy, do not take part in any activity that requires alertness, such as driving a car or operating potentially dangerous machinery. * Before having surgery or any other medical or dental treatment, be sure to tell your doctor or dentist that you are taking this medication. * Morphine has the potential for abuse and must be used with caution. Usually, it should not be taken for longer than ten days (unless your doctor directs you to do so). Tolerance develops quickly; do not increase the dosage or stop taking the drug abruptly, unless you first consult your doctor. If you have been taking large amounts of this drug, or if you have been taking it for long periods of time, you may experience a withdrawal reaction (muscle aches, diarrhea, gooseflesh, runny nose, nausea, vomiting, shivering, trembling, stomach cramps, sleep disorders, irritability, weakness, excessive yawning, or sweating) when you stop taking it. Your doctor may, therefore, want to reduce the dosage gradually. * Be sure to tell your doctor if you are pregnant. The effects of this medication during the early stages of pregnancy have not been thoroughly studied in humans. However, regular use of morphine in large doses during the later stages of pregnancy can result in addiction of the fetus, leading to withdrawal symptoms (irritability, excessive crying, tremors, fever, vomiting, diarrhea, sneezing, or excessive yawning) at birth. Also, tell your doctor if you are breast-feeding an infant. Small amounts of this medication may pass into breast milk and cause excessive drowsiness in the nursing infant. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.