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Morphine

Generic Name: morphine (MOR feen)
Brand Names: Arymo ER, Kadian, MorphaBond ER, MS Contin

What is morphine?

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

Morphine is used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain.

The extended-release form of morphine is for around-the-clock treatment of pain. This form of morphine is not for use on an as-needed basis for pain.

Important information

You should not take morphine if you have severe asthma or breathing problems, a blockage in your stomach or intestines, or a bowel obstruction called paralytic ileus.

Morphine can slow or stop your breathing, and may be habit-forming. MISUSE OF THIS MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

Taking this medicine during pregnancy may cause life-threatening withdrawal symptoms in the newborn.

Fatal side effects can occur if you use this medicine with alcohol, or with other drugs that cause drowsiness or slow your breathing.

Before taking this medicine

You should not take this medicine if you have ever had an allergic reaction to morphine or other narcotic medicines, or if you have:

  • severe asthma or breathing problems; or

  • a blockage in your stomach or intestines.

Do not use morphine if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

To make sure morphine is safe for you, tell your doctor if you have ever had:

  • any type of breathing problem or lung disease;

  • a head injury, brain tumor, or seizures;

  • a drug or alcohol addiction, or mental illness;

  • urination problems;

  • liver or kidney disease;

  • problems with your gallbladder, pancreas, or thyroid; or

  • if you use a sedative like Valium (diazepam, alprazolam, lorazepam, Ativan, Klonopin, Restoril, Tranxene, Versed, Xanax, and others).

Some medicines can interact with morphine and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.

If you use morphine while you are pregnant your baby could become dependent on the drug. This can cause life-threatening withdrawal symptoms in the baby after it is born. Babies born dependent on habit-forming medicine may need medical treatment for several weeks. Tell your doctor if you are pregnant or plan to become pregnant.

Do not breast-feed while taking morphine. This medicine can pass into breast milk and cause drowsiness, breathing problems, or death in a nursing baby.

How should I use morphine?

Take morphine exactly as prescribed by your doctor. Follow all directions on your prescription label. Morphine can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use this medicine in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Morphine may be habit-forming. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICINE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away morphine is against the law.

Stop taking all other around-the-clock narcotic pain medications when you start taking morphine.

Do not crush, chew, or break an extended-release tablet. Swallow it whole to avoid exposure to a potentially fatal dose.

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

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. 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. Ask your doctor how to safely stop using this medicine.

Never crush or break a tablet or capsule to inhale the powder or mix it into a liquid to inject the drug into your vein. This practice has resulted in death with the misuse of morphine and similar prescription drugs.

Store at room temperature, away from heat, moisture, and light. Keep track of your medicine. Morphine is a drug of abuse and you should be aware if anyone is using your medicine improperly or without a prescription.

Do not keep leftover pills or liquid. Ask your pharmacist where to locate a drug take-back disposal program. If there is no take-back program, flush any unused pills or liquid medicine down the toilet.

Dosage Information (comprehensive)

What happens if I miss a dose?

Morphine is sometimes taken only once per day, and sometimes 2 or 3 times per day. Since this medicine is used for pain, you are not likely to miss a dose. If you do miss a dose, take the medicine as soon as you remember. Then take your next dose as follows:

  • If you take morphine 3 times per day: Take your next dose 8 hours after taking the missed dose.

  • If you take morphine 2 times per day: Take your next dose 12 hours after taking the missed dose.

  • If you take morphine 1 time per day: Take your next dose 24 hours after taking the missed dose.

Do not take extra medicine to make up a missed dose. Do not take more than your prescribed dose in a 24-hour period.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A morphine overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, and fainting.

What should I avoid while using morphine?

Do not drink alcohol. Dangerous side effects or death could occur.

This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how morphine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Morphine side effects

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

Like other opioid medicines, morphine can slow your breathing. Death may occur if breathing becomes too weak. A person caring for you should seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Call your doctor at once if you have:

  • slow heart rate, sighing, weak or shallow breathing;

  • chest pain, fast or pounding heartbeats;

  • extreme drowsiness, feeling like you might pass out; or

  • low cortisol levels - nausea, vomiting, loss of appetite, dizziness, worsening tiredness or weakness.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Morphine is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated.

Long-term use of opioid medication may affect fertility (ability to have children) in men or women. It is not known whether opioid effects on fertility are permanent.

Common morphine side effects may include:

  • drowsiness, dizziness;

  • constipation, stomach pain, nausea, vomiting;

  • headache, tired feeling;

  • anxiety; or

  • mild itching.

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.

Side Effects (complete list)

Morphine dosing information

Usual Adult Dose for Pain:

The following dosing recommendations can only be considered suggested approaches to what is actually a series of clinical decisions over time in the management of the pain of each individual patient.

Immediate release tablets:
Opioid naive:
Initial dose: 15 to 30 mg orally every 4 hours as needed

Oral solution:
Opioid naive:
Initial dose: 10 to 20 mg orally every 4 hours as needed

Comments:
-Oral solution: Opioid naive patients should be initiated on 10 mg per 5 mL or 20 mg per 5 mL strengths. Opioid-tolerant patients that have already been titrated to a stable analgesic regimen using lower strengths of morphine may be initiated on the 100 mg per 5 mL (20 mg/mL).

Extended-release oral:
Different extended-release products are not bioequivalent. Conversion from one extended-release product to the same total daily dose of another extended-release product may lead to either excessive sedation at peak or inadequate analgesia at trough. Individual product information should be consulted before prescribing and the dosage should be adjusted to the individual patient.

Opioid naive:
Initial dose: 30 mg orally every 24 hours

Opioid tolerant:
Dose should be taken 1 to 2 times daily depending upon the product prescribed.

Suppository:
10 to 20 mg rectally every 4 hours needed

Subcutaneous/IM:
Initial dose: 10 mg every 4 hours as needed
Dose range: 5 to 20 mg every 4 hours as needed

IV:
-For relief of pain and as preanesthetic:
Initial dose: 4 to 10 mg every 4 hours administered slowly over 4 to 5 minutes
Dose range: 5 to 15 mg
Daily dose range: 12 to 120 mg
Alternate dose: 2 to 10 mg/70 kg of body weight
-Acute myocardial infarction:
Initial dose: 4 to 8 mg
Maintenance dose: 2 to 8 mg every 4 to 15 minutes as needed

Severe chronic pain associated with terminal cancer:
-Continuous IV Infusion: Prior to initiation of the infusion (in concentrations between 0.2 to 1 mg/mL), a loading dose of 15 mg or higher of morphine sulfate may be administered by IV push to alleviate pain.
-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.

Epidural:
Initial dose: 5 mg in the lumbar region may provide satisfactory pain relief for up to 24 hours. If adequate pain relief is not achieved within one hour, careful administration of incremental doses of 1 to 2 mg at intervals sufficient to assess effectiveness may be given.
Maximum dose: 10 mg per 24 hr

Intrathecal:
-Dosage is usually one-tenth that of epidural dosage
-Initial dose: 0.2 to 1 mg may provide satisfactory pain relief for up to 24 hours. Repeated intrathecal injections are not recommended.

Usual Pediatric Dose for Pain:

-The following dosing recommendations can only be considered suggested approaches to what is actually a series of clinical decisions over time in the management of the pain of each individual patient.
-Safety and efficacy of this drug in neonates have not been established. Opiate agonists should not be used in premature neonates since the drugs cross the immature blood-brain barrier more readily than in the mature barrier producing disproportionate respiratory depression. Opiates should be administered with caution and in monitored dosages to infants and small children since they may be relatively more sensitive to opiates on a body weight basis.

-Subcutaneous: 0.1 to 0.2 mg per kg as needed. Not to exceed 15 mg per dose.
-IV: 50 to 100 mcg (0.05 to 0.1 mg) per kg, administered very slowly. Not to exceed 10 mg per dose.

Usual Pediatric Dose for Neonatal Abstinence Syndrome:

Less than 1 month:
WEIGHT-BASED DOSING: 0.04 mg/kg orally every 3 to 4 hours
Maximum dose: 0.2 mg/kg

SYMPTOM-BASED DOSING (Neonatal Abstinence Syndrome [NAS] Score):
-NAS Score 9 to 12; Dose: 0.04 mg orally every 4 hours
-NAS Score 13 to 16; Dose: 0.08 mg orally every 4 hours
-NAS Score 17 to 20; Dose: 0.12 mg orally every 4 hours
-NAS Score 21 to 24; Dose: 0.16 mg orally every 4 hours
-NAS Score greater than 25; Dose: 0.2 mg orally every 4 hours

WEANING: After 48 hours of Clinical Stability
-Reduce dose by 10% every 24 to 48 hours
-Cease therapy when dose is 0.15 mg/kg/day

Comments:
-Approximately 60% to 80% of neonates with NAS may not respond to nonpharmacologic treatment and will require medication.
-The optimal pharmacologic treatment approach continues to be studied, however, oral morphine has been commonly used for this purpose.
-Pharmacologic treatment is initiated/titrated/weaned as part of an overall treatment strategy based on neonatal abstinence scores (e, g. Finnegan scores).
-The Finnegan scoring system has been standardized for use in term infants; its use in preterm or older infants should be considered not standardized; additionally, significant intra-observer variability has been documented.

Use: For the pharmacologic treatment of neonatal abstinence syndrome in accordance with treatment protocols developed by neonatology experts.

What other drugs will affect morphine?

Narcotic (opioid) medication can interact with many other drugs and cause dangerous side effects or death. Be sure your doctor knows if you also use:

  • other narcotic medications - opioid pain medicine or prescription cough medicine;

  • drugs that make you sleepy or slow your breathing - a sleeping pill, muscle relaxer, sedative, tranquilizer, or antipsychotic medicine; or

  • drugs that affect serotonin levels in your body - medicine for depression, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting.

This list is not complete. Other drugs may interact with morphine, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about morphine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use morphine only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2017 Cerner Multum, Inc. Version: 12.01.

Last reviewed: September 08, 2017
Date modified: October 05, 2017

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