Morphine

Generic Name: morphine (MOR feen)
Brand names: AVINza, Kadian, MS Contin, MSIR, Oramorph SR

What is morphine?

Morphine is an opioid pain medication. An opioid is sometimes called a narcotic.p>

Morphine is used to treat moderate to severe pain. Short-acting forumations are taken as needed for pain. Extended-release morphine is for use when around-the-clock pain relief is needed.

Morphine is not for treating pain just after surgery unless you were already taking morphine before the surgery.

Morphine may also be used for purposes not listed in this medication guide.

Important information about morphine

You may not be able to take morphine unless you are already being treated with a similar opioid pain medicine and your body is tolerant to it. Talk with your doctor if you are not sure you are opioid-tolerant.

Morphine may be habit-forming and should be used only by the person it was prescribed for. Keep the medication in a secure place where others cannot get to it. Do not drink alcohol while you are using morphine. Dangerous side effects or death can occur when alcohol is combined with morphine. Check your food and medicine labels to be sure these products do not contain alcohol.

Video: Treatment for Depression

Never take morphine in larger amounts, or for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Do not stop using morphine suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using morphine.

Before using morphine

Do not use morphine if you have ever had an allergic reaction to a narcotic medicine (examples include methadone, morphine, Oxycontin, Darvocet, Percocet, Vicodin, Lortab, and many others), or to a narcotic cough medicine that contains codeine, hydrocodone, or dihydrocodeine. You should also not take morphine if you are having an asthma attack, or if you have a bowel obstruction called paralytic ileus.

Do not use morphine if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

To make sure you can safely take morphine, tell your doctor if you have any of these other conditions:

• a blockage in your digestive tract (stomach or intestines);

• asthma, COPD, sleep apnea, or other breathing disorders;

• liver or kidney disease;

• underactive thyroid;

• curvature of the spine;

• a history of head injury or brain tumor;

• epilepsy or other seizure disorder;

• low blood pressure;

• gallbladder disease;

• Addison's disease or other adrenal gland disorders;

• enlarged prostate, urination problems;

• mental illness; or

• a history of drug or alcohol addiction.

Morphine may be habit forming and should be used only by the person it was prescribed for. Never share morphine with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

You may not be able to take morphine unless you are already being treated with a similar opioid pain medicine and your body is tolerant to it. Talk with your doctor if you are not sure you are opioid-tolerant.

FDA pregnancy category C. It is not known whether morphine will harm an unborn baby. Morphine may cause addiction or withdrawal symptoms in a newborn if the mother takes the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. Morphine can pass into breast milk and may harm a nursing baby. Do not use morphine without telling your doctor if you are breast-feeding a baby.

See also: Morphine pregnancy and breastfeeding warnings (in more detail)

Older adults and those who are ill or debilitated may be more likely to have serious side effects.

How should I use morphine?

Take morphine exactly as prescribed. Never take morphine in larger amounts, or for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Do not crush, chew, or break an extended-release morphine tablet. Swallow the pill whole. It will release medicine slowly in the body. Breaking the pill would cause too much of the drug to be released at one time.

To make swallowing easier, you may open the extended-release morphine capsule and sprinkle the medicine into a spoonful of applesauce. Swallow this mixture right away without chewing. Do not save the mixture for later use. Discard the empty capsule.

Measure liquid morphine medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Do not stop using morphine suddenly, or you could have unpleasant withdrawal symptoms. Talk to your doctor about how to avoid withdrawal symptoms when stopping the medication. You may need to use less and less before you stop the medication completely.

Store morphine at room temperature, away from heat, moisture, and light.

Keep track of the amount of medicine used from each new bottle. Morphine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Always check your bottle to make sure you have received the correct pills (same brand and type) of medicine prescribed by your doctor. Ask the pharmacist if you have any questions about the medicine you receive at the pharmacy.

After you have stopped using morphine, flush any unused pills down the toilet. Throw away any unused liquid morphine that is older than 90 days. Disposal of medicines by flushing is recommended to reduce the danger of accidental overdose causing death. This advice applies to a very small number of medicines only. The FDA, working with the manufacturer, has determined this method to be the most appropriate route of disposal and presents the least risk to human safety.

What happens if I miss a dose?

Since morphine is sometimes used as needed, you may not be on a dosing schedule. If you are using the medication regularly, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not use extra medicine to make up the missed dose.

Extended-release morphine is not for use on an as-needed basis for pain.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of morphine can be fatal.

Overdose symptoms may include extreme drowsiness, pinpoint pupils, confusion, cold and clammy skin, weak pulse, shallow breathing, fainting, or breathing that stops.

What should I avoid while using morphine?

Do not drink alcohol while you are taking this medication. Dangerous side effects or death can occur when alcohol is combined with morphine. Check your food and medicine labels to be sure these products do not contain alcohol. This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how morphine will affect you.

Morphine side effects

Get emergency medical help if you have any of these signs of an allergic reaction to morphine: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• shallow breathing, slow heartbeat;

• stiff muscles, seizure (convulsions);

• cold, clammy skin;

• confusion, unusual thoughts or behavior;

• severe weakness, feeling like you might pass out;

• trouble swallowing;

• urinating less than usual or not at all;

• pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or

• easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin.

Less serious morphine side effects may include:

• weight loss;

• constipation, diarrhea;

• nausea, vomiting, stomach pain, loss of appetite;

• flushing (warmth, redness, or tingly feeling);

• headache, dizziness, spinning sensation;

• memory problems; or

• sleep problems (insomnia), strange dreams.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Morphine side effects (in more detail)

Morphine Dosing Information

Usual Adult Dose of Morphine for Pain:

Oral, Sublingual, or Buccal: 5 to 30 mg every 3 to 4 hours as needed
Extended release: range from 10 mg to 600 mg daily, given in equally divided doses every 8 to 12 hours or given as one dose every 24 hours
IM or subcutaneous: 2.5 to 20 mg every 3 to 4 hours as needed
IV: 4 to 15 mg every 3 to 4 hours as needed. Give very slowly over 4 to 5 minutes. Starting doses up to 15 mg every 4 hours have been used. Chest pain: 2 to 4 mg repeat as necessary
Continuous IV: 0.8 to 10 mg/hour. Maintenance dose: 0.8 to 80 mg/hour. Rates up to 440 mg/hour have been used.
IV patient controlled analgesia or subcutaneous patient controlled analgesia: 1 to 2 mg injected 30 minutes after a standard IV dose of 5 to 20 mg. The lockout period is 6 to 15 minutes. The 4 hour limit is 30 mg.
Continuous subcutaneous: 1 mg/hour after a standard dose of 5 to 20 mg
Epidural: 5 mg one time. May give 1 to 2 mg more after one hour to a maximum of 10 mg.
Intrathecal: 0.2 to 1 mg one time
Intrathecal Continuous: 0.2 mg/24 hours. May be increased up to 20 mg/24 hours.
Intracerebroventricular: 0.25 mg via an Ommaya reservoir.
Rectal: 10 to 30 mg every 4 hours as needed.

Usual Pediatric Dose of Morphine for Pain:

Less than or equal to 4 weeks:
Use preservative-free formulation:
Initial: 0.05 mg/kg IM, IV, or subcutaneously every 4 to 8 hours titrating carefully to effect
Maximum dose: 0.1 mg/kg/dose
Continuous Infusion: 0.01 mg/kg/hour continuous IV infusion. Do not exceed infusion rates of 0.015 to 0.02 mg/kg/hour.

Greater than or equal to 1 month but less than 12 years:
Oral: 0.2 to 0.5 mg/kg/dose every 4 to 6 hours (tablets/solution) or 0.3 to 0.6 mg/kg/dose every 12 hours (extended release)
IM,subcutaneous, IV: 0.05 to 0.2 mg/kg/dose (up to 15 mg) every 4 hours as needed.
IV/subcutaneous Continuous: 0.025 to 0.206 mg/kg/hour (sickle cell or cancer pain) or 0.01 to 0.04 mg/kg/hour (postop pain)
Epidural (use preservative-free formulation): 0.025 mg/kg/dose every 6 to 8 hours (postop pain). Maximum per 24 hours: 5 mg.

Greater than or equal to 12 years:
Premedication for anesthesia IV: 3 to 4 mg once, may repeat in 5 minutes if necessary.
Oral: 0.2 to 0.5 mg/kg/dose every 4 to 6 hours (tablets/solution) or 0.3 to 0.6 mg/kg/dose every 12 hours (extended release)
IM,subcutaneous, IV: 0.05 to 0.2 mg/kg/dose (up to 15 mg) every 4 hours as needed
IV/subcutaneous Continuous: 0.025 to 0.206 mg/kg/hour (sickle cell or cancer pain) or 0.01 to 0.04 mg/kg/hour (postop pain)
Epidural (use preservative-free formulation): 0.025 mg/kg/dose every 6 to 8 hours (postop pain). Maximum per 24 hours: 5 mg.
IV patient controlled analgesia: 0.015 mg/kg/dose (postop pain); lockout period of 10 minutes; 4 hour limit of 0.25 mg/kg.

What other drugs will affect morphine?

Do not take morphine with any other narcotic pain medications, antidepressants, sedatives, tranquilizers, sleeping pills, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result.

Tell your doctor about all other medicines you use, especially:

• cimetidine (Tagamet);

• buprenorphine (Buprenex, Subutex);

• butorphanol (Stadol);

• nalbuphine (Nubain);

• pentazocine (Talwin); or

• a diuretic (water pill).

This list is not complete and other drugs may interact with morphine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about morphine.