UK Edition. Click here for US version.
MST CONTINUS SUSPENSION 20MG
Active substance(s): MORPHINE SULPHATE
Package leaflet: Information for the user
MST® Continus® 20 mg, 30 mg, 60 mg, 100 mg
and 200 mg prolonged-release suspensions
Read all of this leaflet carefully before
you start taking this medicine because
it contains important information for
• Keep this leaflet. You may need to read
• If you have any further questions, ask
your doctor or pharmacist.
• This medicine has been prescribed for
you only. Do not pass it on to others. It
may harm them, even if their signs of
illness are the same as yours.
• If you get any side effects, talk to your
doctor or pharmacist. This includes any
possible side effects not listed in this
leaflet. See section 4.
What is in this leaflet:
1. What MST Continus suspension is and
what it is used for
2. What you need to know before you take
MST Continus suspension
3. How to take MST Continus suspension
4. Possible side effects
5. How to store MST Continus
6. Contents of the pack and other
1. What MST Continus suspension is
and what it is used for
This suspension has been prescribed for
you by your doctor to relieve severe pain
over a period of 12 hours. It contains the
active ingredient morphine which belongs
to a group of medicines called strong
analgesics or ‘painkillers’.
2. What you need to know before you
take MST Continus suspension
Do not take MST Continus suspension
• you are allergic (hypersensitive)
to morphine or any of the other
ingredients of the suspension (listed in
• you have breathing problems, such
as obstructive airways disease or
respiratory depression. Your doctor
will have told you if you have these
conditions. Symptoms may include
breathlessness, coughing or breathing
more slowly or weakly than expected;
• you have a head injury that causes a
severe headache or makes you feel sick.
This is because the suspensions may
make these symptoms worse or hide the
extent of the head injury;
• you have a condition where the small
bowel (part of your gut) does not
work properly (paralytic ileus), your
stomach empties more slowly than it
should (delayed gastric emptying) or
you have severe pain in your abdomen;
• you have recent onset liver disease;
• you are taking a type of medicine
known as a monoamine oxidase
inhibitor (examples include
isocarboxazid, moclobemide and
linezolid), or you have taken this type
of medicine in the last two weeks;
• the patient is under one year of age.
If you are going to have an operation,
please tell the doctor at the hospital that
you are taking this suspension.
Warnings and precautions
Talk to your doctor or pharmacist before
taking MST Continus suspension if you:
• have breathing problems, such as
severe bronchial asthma or impaired
lung function. Your doctor will have
told you if you have these conditions.
Symptoms may include breathlessness
• have an under-active thyroid gland
(hypothyroidism), kidney or long-term
liver problems as you may need a lower
• have a severe headache or feel sick as
this may indicate that the pressure in
your skull is increased;
• suffer from, or have ever suffered from
epilepsy, seizures, fits or convulsions;
• have low blood pressure;
• have a severe heart problem after
long-term lung disease (severe cor
• have inflammation of the pancreas
(which causes severe pain in the
abdomen and back) or problems with
your gall bladder;
• have an inflammatory bowel disorder;
• have prostate problems;
• have poor adrenal gland function (your
adrenal gland is not working properly
which may cause symptoms including
weakness, weight loss, dizziness,
feeling or being sick);
• are or have ever been addicted to
alcohol or drugs;
• have previously suffered from
withdrawal symptoms such as agitation,
anxiety, shaking or sweating, upon
stopping taking alcohol or drugs.
• have an increased sensitivity to pain
despite the fact that you are taking
increasing doses of the suspension
(hyperalgesia). Your doctor will
decide whether you need a change in
dose or a change in strong analgesic
You may experience hormonal changes
while taking these tablets. Your doctor
may want to monitor these changes.
Other medicines and MST Continus
Concomitant use of opioids and
benzodiazepines increases the risk of
drowsiness, difficulties in breathing
(respiratory depression), coma and
may be life-threatening. Because of
this, concomitant use should only be
considered when other treatment options
are not possible.
However if your doctor does prescribe
benzodiazepines or related drugs with
opioids the dosage and duration of
concomitant treatment should be limited
by your doctor.
Please follow your doctor’s dosage
recommendation closely. It could be
helpful to inform friends or relatives to be
aware of sign and symptoms stated above.
Contact your doctor when experiencing
Tell your doctor or pharmacist if you
are taking, have recently taken, or might
take any other medicines. If you take the
suspension with some other medicines,
the effect of the suspension or the other
medicine may be changed.
The suspension must not be used together
with a monoamine oxidase inhibitor, or if
you have taken this type of medicine in
the last two weeks (see section 2 ‘Do not
If you need to take a medicine for
indigestion, do not take it for 2 hours after
taking your suspension.
Tell your doctor or pharmacist if you are
• medicines to help you sleep (for example
tranquillisers, hypnotics or sedatives);
• medicines to treat psychiatric or mental
disorders (such as phenothiazines);
• muscle relaxants;
• medicines to treat high blood pressure;
• cimetidine to treat stomach ulcers,
indigestion or heartburn;
• certain types of medicines to stop you
feeling or being sick;
• medicines used to prevent or
relieve the symptoms of an allergy
• other strong analgesics or ‘painkillers’
(such as buprenorphine, nalbuphine or
• rifampicin to treat tuberculosis;
• ritonavir to treat HIV;
• medicines to treat Parkinson’s disease;
• gabapentin to treat epilepsy or
neuropathic pain (pain due to nerve
Also tell your doctor if you have recently
been given an anaesthetic.
MST Continus suspension with alcohol
Drinking alcohol whilst taking
MST Continus suspension may make
you feel more sleepy or increase the
risk of serious side effects such as
shallow breathing with a risk of stopping
breathing, and loss of consciousness. It is
recommended not to drink alcohol while
you’re taking MST Continus suspension.
Pregnancy, breast-feeding and fertility
If you are pregnant or breast-feeding,
think you may be pregnant or are planning
to have a baby, ask your doctor or
pharmacist for advice before taking this
Prolonged use of morphine during
pregnancy may cause withdrawal
symptoms in newborns. Withdrawal
symptoms in babies born to mothers who
have used MST Continus suspension
in pregnancy may include high-pitched
crying, irritability and restlessness,
shaking (tremor), feeding difficulties and
Details regarding a new driving offence
concerning driving after drugs have been
taken in the UK may be found here:
Talk to your doctor or pharmacist if you
are not sure whether it is safe for you to
drive while taking this medicine.
Driving and using machines
The suspension may cause a number of
side effects such as drowsiness which
could affect your ability to drive or use
machinery (see section 4 for a full list
of side effects). These are usually most
noticeable when you first start taking the
suspension, or when changing to a higher
dose. If you are affected you should not
drive or use machinery.
This medicine can affect your ability to
drive as it may make you sleepy or dizzy.
• Do not drive while taking this medicine
until you know how it affects you.
• It is an offence to drive while you
have this medicine in your body over
a specified limit unless you have a
defence (called the ‘statutory defence’).
• This defence applies when:
• The medicine has been prescribed
to treat a medical or dental problem;
• You have taken it according to the
instructions given by the prescriber
and in the information provided with
• Please note that it is still an offence to
drive if you are unfit because of the
medicine (i.e. your ability to drive is
MST Continus suspension contains
Ponceau 4R (E124) which may cause
3. How to take MST Continus
Always take this medicine exactly as your
doctor or pharmacist has told you. The
label on your medicine will tell you how
much suspension to take and how often.
Check with your doctor or pharmacist if
you are not sure.
The usual way to take the suspension is to
put the following amount of water into a
For one 20 mg sachet, use 10 ml water
For one 30 mg sachet, use 10 ml water
For one 60 mg sachet, use 10 ml water
For one 100 mg sachet, use 20 ml water
For one 200 mg sachet, use 30 ml water
Cut or tear the top off the sachet.
Empty the contents of the sachet into
the measuring cup of water. Stir with a
spoon for 10 seconds. The suspension
contains tiny beads (granules) that will
not dissolve. Swallow all the suspension
at once. If any suspension remains in the
beaker rinse with a little more water and
If you prefer, you can sprinkle the
granules on to cold soft food, such as
You must only take the suspension by
mouth. Do not crush, chew or inject the
MST Continus suspension is designed
to work properly over 12 hours. The
granules must be suspended in water
and drunk immediately. If the granules
are crushed or chewed, the entire 12hour dose may be absorbed rapidly
into your body. This can be dangerous,
causing serious problems such as an
overdose, which may be fatal.
You should take your suspension every 12
hours. For instance, if you take a dose at
8 o’clock in the morning, you should take
the next dose at 8 o’clock in the evening.
The usual starting dose is 20 mg to 30 mg
taken every 12 hours. However, the dose
will depend on your age, weight and the
severity of your pain.
Use in children over one year of age
Children over one year of age can take the
suspension. The required dose will depend
on their weight and severity of pain. This
should be discussed with your doctor or
If you find that you are still in pain whilst
taking the suspension discuss this with
Do not exceed the dose recommended by
your doctor. You should check with your
doctor or pharmacist if you are not sure.
If you take more MST Continus
suspension than you should
Call your doctor or hospital straight away
as you may need emergency treatment
in hospital. People who have taken an
overdose may feel very sleepy, sick,
dizzy or get pneumonia from inhaling
vomit or foreign matter (symptoms may
include breathlessness, cough and fever).
They may also have breathing difficulties
leading to unconsciousness or even death.
When seeking medical attention make
sure that you take this leaflet and any
remaining suspensions with you to show
to the doctor.
If you forget to take MST Continus
If you remember within 4 hours of the
time your suspension was due, take it
straight away. Take your next dose at your
normal time. Do not take a double dose to
make up for a forgotten dose.
If you stop taking MST Continus
You should not suddenly stop taking
this suspension unless your doctor tells
you to. If you want to stop taking your
suspension, discuss this with your doctor
first. They will tell you how to do this,
usually by reducing the dose gradually so
you do not experience unpleasant effects.
Withdrawal symptoms such as agitation,
anxiety, shaking or sweating may occur if
you suddenly stop taking the suspension.
If you have any further questions on the
use of this medicine, ask your doctor or
4. Possible side effects
Like all medicines, this medicine can
cause side effects, although not everybody
All medicines can cause allergic reactions,
although serious allergic reactions are
uncommon. Tell your doctor immediately
if you get any sudden wheeziness,
difficulties in breathing, swelling of
the eyelids, face or lips, rash or itching
especially those covering your whole
The most serious side effect is a condition
where you breathe more slowly or weakly
than expected (respiratory depression).
As with all strong painkillers, there is a
risk that you may become addicted or
reliant on the suspension.
Very common side effects (may affect
more than 1 in 10 people)
• Constipation (your doctor can prescribe
a laxative to overcome this problem).
• Feeling sick.
Common side effects (may affect up to 1
in 10 people)
• Drowsiness (this is most likely when
you first start taking your suspension
or when your dose is increased, but it
should wear off after a few days).
• Dry mouth, loss of appetite, abdominal
pain or discomfort.
• Vomiting (being sick). (This should
normally wear off after a few days.
However your doctor can prescribe an
anti-vomiting medicine if it continues
to be a problem.)
• Dizziness, headache, confusion,
difficulty in sleeping.
• A feeling of unusual weakness.
• Generally feeling unwell, tiredness.
• Involuntary muscle contractions.
• Rash or itchy skin.
Uncommon side effects (may affect up to
1in 100 people)
• Difficulty in breathing (possibly due to
fluid on the lungs) or wheezing.
• A condition where the bowel does not
work properly (ileus).
• Changes in taste, indigestion.
• A feeling of dizziness or ‘spinning’,
fainting, seizures, fits or convulsions.
• Agitation, mood changes,
hallucinations, a feeling of extreme
• Unusual muscle stiffness.
• Tingling or numbness.
• Difficulty in passing urine.
• Low blood pressure, facial flushing
(redness of the face).
• Swelling of the hands, ankles or feet.
• A worsening in liver function tests
(seen in a blood test).
• Blurred vision.
• Muscle spasms.
Frequency not known (frequency cannot
be estimated from the available data)
• Unpleasant or uncomfortable mood,
• An increased sensitivity to pain.
• Reduction in size of the pupils in the
A fast or slow heartbeat.
High blood pressure.
Decreased cough reflex.
Colicky abdominal pain or discomfort,
an increase in the severity of symptoms
associated with inflammation of the
pancreas (severe pain in the abdomen
Impotence, decreased sexual drive,
absence of menstrual periods.
Withdrawal symptoms (See section 3
“If you stop taking MST Continus
A need to take increasingly higher
doses of MST Continus suspension
to gain the same level of pain relief
Withdrawal symptoms in babies
born to mothers who have used MST
Continus suspension in pregnancy (See
section 2 ‘Pregnancy, breastfeeding and
Reporting of side effects
If you get any side effects, talk to your
doctor, pharmacist or nurse. This includes
any possible side effects not listed in this
leaflet. You can also report side effects
directly via the Yellow Card Scheme at:
By reporting side effects you can help
provide more information on the safety of
5. How to store MST Continus
Keep this medicine out of the sight and
reach of children.
Do not use this medicine after the expiry
date which is stated on the sachet and
carton. The expiry date refers to the last
day of that month.
Do not store your suspension above 25ºC.
Do not throw away any medicines via
wastewater or household waste. Ask your
pharmacist how to throw away medicines
you no longer use. These measures will
help protect the environment.
6. Contents of the pack and other
What MST Continus suspensions
The active substance is morphine sulfate.
Each sachet contains 20 mg, 30 mg,
60 mg, 100 mg or 200 mg of morphine
The other ingredients are:
• Cationic exchange resin
• Xanthan gum
• Raspberry flavour
• Ponceau 4R (E124)
What MST Continus suspensions look
like and the contents of the pack
The suspension sachets contain pink
granules with an odour of raspberries.
The sachets are coloured as follows:
20 mg – blue, 30 mg – dark purple,
60 mg – orange, 100 mg – grey,
200 mg – teal green.
In each box there are 30 sachets.
Marketing Authorisation Holder and
The suspensions are made by
Bard Pharmaceuticals Limited for the
marketing authorisation holder
Napp Pharmaceuticals Limited, both at
Cambridge Science Park, Milton Road,
Cambridge CB4 0GW, UK.
This leaflet is also available in large print, Braille or as an
audio CD. To request a copy, please call the RNIB Medicine
Information line (free of charge) on:
0800 198 5000
You will need to give details of the product name and
reference number. These are as follows:
Product name: MST Continus suspension
Reference number: 16950/0030
This leaflet was last revised in January 2018.
MST® Continus® suspensions are protected by European Patent (UK) No. 0847273.
® MST, Continus, MST Continus, NAPP and the NAPP logo are registered trade
© 2009 - 2017 Napp Pharmaceuticals Limited.
Source: Medicines and Healthcare Products Regulatory Agency
Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.