IPECACUANHA AND MORPHINE MIXTURE BP 1980
NAME OF THE MEDICINAL PRODUCT
Ipecacuanha and Morphine Mixture BP 1980
QUALITATIVE AND QUANTITATIVE COMPOSITION
Liquorice Liquid Extract
0.458mg per 5ml.
0.1ml per 5ml.
0.525ml per 5ml.
For the symptomatic relief of coughs.
Posology and method of administration
Recommended doses and dosage schedule
Adults and children over 12 years: 10ml.
The elderly and Debilitated Patients, use with caution; a reduced dose can be
recommended by a doctor.
This dose can be repeated up to 4 times in any 24 hours.
Hypersensitivity to the active substances or to any of the excipients.
Children under the age of 12 years.
Respiratory depression, and when there is a risk of paralytic ileus.
Acute alcoholism, head injuries and raised intracranial pressure, comatose
patients, delayed gastric emptying, acute abdomen and phaeochromocytoma and
obstructive or inflammatory bowel disorders.
It should not be given during an attack of asthma or to patients with heart failure
secondary to chronic lung disease.
Special warnings and precautions for use
Use with care in hypotension, shock, myasthenia gravis, prostatic hypertrophy,
diseases of the biliary tract, convulsive disorders, pancreatitis, and cardiac
arrhythmias. Caution is advised in patients with asthma or other respiratory
disorders, hepatic and renal disease, and a history of drug abuse.
Cough suppressants may cause sputum retention and this may be harmful in
patients with chronic bronchitis and bronchiectasis.
A reduced dose is recommended in elderly or debilitated patients, in hepatic and
renal impairment (but avoid if severe), in hypothyroidism, and in adrenocortical
Administration of some opioid analgesics to patients taking a monoamine
oxidase inhibitor (MAOI) has been associated with very severe and sometimes
fatal reactions. If the use of Ipecacuanha and Morphine Mixture is considered
essential, then great care should be taken in patients taking MAOIs or within 14
days of stopping MAOIs (see section 4.5).
Patients with rare hereditary problems of fructose intolerance, glucose-galactose
malabsorption or sucrase-isomaltase insufficiency should not take this medicine.
This medicinal product contains 3.1 vol% ethanol (alcohol) i.e. up to 245 mg per
10 ml dose, equivalent to 6 ml beer or 3 ml wine per dose. It is harmful for
those suffering from alcoholism. To be taken into account in pregnant or breastfeeding women, children and high-risk groups such as patients with liver
disease, or epilepsy.
Do not exceed the stated dose.
If symptoms persist consult your doctor.
The elderly. Ask your doctor for advice; a lower dose might be
Do not give to children under 12 years old.
Keep out of the sight and reach of children.
Shake the bottle.
Interaction with other medicinal products and other forms of interaction
Morphine may potentiate the effects of baclofen, esmolol and gabapentin. The
efficacy of rifampicin may be reduced by morphine. The plasma concentration
of morphine may be reduced by ritonavir. Morphine may have an additive
sedative effect if taken with benzodiazepines.
As an opioid analgesic, morphine may also interact with a range of other drugs
if given concomitantly. Effects of the following drugs may be enhanced if
given with opioid analgesics: alcohol, general anaesthetics (intravenous and
volatile gases), tricyclic antidepressants, sedating antihistamines, antipsychotics,
sodium oxybate, anxiolytics and hypnotics.
The CNS effects of opioid analgesics may be enhanced by barbiturates and by
cisapride. The metabolism of opioid analgesics is inhibited by cimetidine.
The effects of other drugs may be reduced if given with opioid analgesics:
ciprofloxacin (when used for surgical prophylaxis), cisapride, mexiletine,
domperidone and metoclopramide.
Possible CNS excitation or depression (hypertension or hypotension) can occur
when opioid analgesics are given with antidepressants such as MAOIs, e.g.
moclobemide and selegiline (avoid concomitant use and for 2 weeks after
Pregnancy and Lactation
As with all medicines use should be avoided during pregnancy, especially in
the first trimester, and in lactation unless recommended by a doctor.
Effects on ability to drive and use machines
Although considered unlikely with this product, morphine may cause
drowsiness and other central nervous system disorders which may have an
effect on the ability to drive or operate machinery. If affected, patients should
not drive or operate machinery.
This medicine can impair cognitive function and can affect a patient’s ability to
drive safely. This class of medicine is in the list of drugs included in regulations
under 5a of the Road Traffic Act 1988. When prescribing this medicine, patients
should be told:
• The medicine is likely to affect your ability to drive
• Do not drive until you know how the medicine affects you
• It is an offence to drive while under the influence of this medicine
• However, you would not be committing an offence (called “statutory
o The medicine has been prescribed to treat a medical or dental problem
o You have taken it according to the instructions given by the prescriber
and in the information provided with the medicine and
o It was not affecting your ability to drive safely
Adverse effects would not be expected to occur when this preparation is taken at the
The following undesirable effects have been reported for use of morphine or opioid
analgesics and may arise from use of Ipecacuanha and Morphine Mixture. The
frequency of adverse effects cannot be estimated from available data.
Psychiatric disorders: hallucinations, dysphoria, euphoria, mood changes,
confusion, dependence, restlessness, agitation, delirium, disorientation, excitation
Nervous system disorders: dizziness, drowsiness, sleep disturbances, headache,
vertigo, raised intracranial pressure, malaise, seizures, paraesthesia
Eye disorders: miosis, visual disturbances, nystagmus
Cardiac disorders: palpitations, bradychardia, tachycardia
Vascular disorders: postural hypotension, hypotension, hypothermia, facial flushing,
oedema, hypertension, syncope
Respiratory, thoracic and mediastinal disorders: respiratory depression (with
larger doses), bronchospasm
Gastrointestinal disorders: nausea, vomiting, constipation, abdominal pain,
anorexia, exacerbation of pancreatitis, dry mouth, paralytic ileus, dyspepsia, taste
Hepatobiliary disorders: biliary spasm
Skin and subcutaneous tissue disorders: rashes, urticaria, pruritis, sweating
Musculoskeletal and connective tissue disorders: muscular rigidity (with higher
doses), muscle fasciculation, myoclonus
Renal and urinary disorders: difficulty with micturition, urinary retention, ureteric
Reproductive system and breast disorders: decreased libido or potency,
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is
important. It allows continued monitoring of the benefit/risk balance of the medicinal
product. Healthcare professionals are asked to report any suspected adverse reactions
via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
Overdose with this preparation is unlikely to occur due to the low concentrations
of the active ingredients present.
Large doses of ipecacuanha irritate the gastro-intestinal tract and may give rise
to bloody vomiting and diarrhoea. Absorption of emetine may have adverse
effects on the heart, such as conduction abnormalities or myocardial infarction.
Respiratory depression, nausea and vomiting may occur due to the morphine.
Large doses of opioids may also produce pin point pupils, hypotension,
circulatory failure and coma.
After acute overdosage of ipecacuanha, activated charcoal should be given to
delay absorption, followed by gastric lavage if necessary. Excessive vomiting
should be controlled by administration of an antiemetic, fluid and electrolyte
imbalance corrected if necessary and facilities should be available to correct any
cardiac effects and subsequent shock.
In acute opioid poisoning the stomach should be emptied by aspiration and
lavage, intensive supportive therapy may be required to correct respiratory
failure and shock. Activated charcoal may be given orally in conscious patients
if a substantial overdose has been ingested within 1 hour provided that the
airway can be protected.
Severe respiratory depression and coma produced by excessive doses of opioids
can be counteracted by the administration of naloxone given intravenously at a
dose of 0.4 to 2 mg, repeated at 2-3 minute intervals if necessary, up to 10 mg.
Excessive use of liquorice may cause sodium and water retention, hypertension
Ipecacuanha is an expectorant, and in larger doses an emetic.
Morphine is an opioid analgesic acting mainly on the central nervous system
and smooth muscle. It is used for relief of moderate to severe pain and is also
effective as a cough suppressant.
Emetine one of the major alkaloids of ipecacuanha is excreted or metabolised
slowly, it has been detected in urine 40-60 days after discontinuation of
Morphine salts are absorbed from the gastro-intestinal tract. Morphine is
distributed throughout the body. It crosses the placenta and traces have been
found in milk and sweat.
Conjugation to morphine 3- and 6- glucuronides occurs in the liver. About
10% of a dose is excreted through the bile into the faeces, the remainder being
excreted in the urine in the form of conjugates. About 90% of total morphine
is excreted in 24 hours with traces up to 48 hours.
Preclinical Safety Data
List of Excipients
Treacle Black Commercial, Peppermint Oil, Ethanol (96%), Diethyl Ether
(Peroxide Free), Chloroform, Syrup and Purified Water.
18 months unopened, 8 weeks after first opening.
Special Precautions for Storage
Store below 25°C.
Nature and contents of container
200ml: Amber glass bottle with plastic screw cap and liner or white 28mm
Child-resistant cap with Tamper Evident band and EPE/Saranex Liner.
Instructions for Use/Handling and Disposal
MARKETING AUTHORISATION HOLDER
Thornton & Ross Limited
MARKETING AUTHORISATION NUMBER
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
DATE OF REVISION OF THE TEXT