Morphine Sulfate

  • Generic Name or Active Ingridient: Morphine

Uses

Doctors prescribe morphine sulfate to treat severe acute and chronic pain. This medication is to be used by patients whose pain does not respond to non-opioid pain relievers and who need pain relief for more than a few days. A physician may recommend morphine sulfate to patients experiencing dyspnea associated with acute left ventricular failure, which is difficulty breathing as a result of the type of heart failure. Morphine sulfate may be used for sedation before surgery, along with anesthesia or to provide pain relief during labor. This medication should be used only by patients who are already tolerant to opioids; this means a patient should have already been taking another narcotic pain reliever for at least several days before taking morphine sulfate. Learn More About Morphine Sulfate Uses

Other, off label uses for this medicine

A physician may prescribe morphine sulfate to patients with acute pulmonary edema because of morphine sulfates cardiovascular effects and to calm anxiety. Do not use morphine sulfate if the pulmonary edema is a result of a chemical respiratory irritant.

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Administration/Dosage

Morphine sulfate is available as tablets, capsules, injectable solution, oral solution or as a rectal suppository. Brand names of injectable morphine sulfate include Astramorph PF and Duramorph, Infumorph. Injectable morphine sulfate doses range from 0.5 mg/mL to 25 mg/mL. Extended release morphine sulfate is available in capsule from under the brand name Avinza, with dosages ranging from 30 mg to 120 mg per capsule. Another extended release morphine sulfate brand name, Kadian, is available in 20 mg, 50 mg and 100 mg capsules. Controlled release morphine sulfate brand name tablets include MS Contin and Oramorph SR, with dosages ranging from 15 mg to 200 mg per tablet. Brand name oral solutions include MSIR, OMS Concentrate, Roxanol, Roxanol Rescudose, Roxanol 100, Roxanol T and Roxanol UD. Rectal suppositories, sold under the brand name RMS, are available in 5 mg, 10 mg, 20 mg and 30 mg strengths.

The typical oral solution morphine sulfate prescription for adults calls for 10 mg to 30 mg every 4 hours as necessary or as prescribed by a physician. An extended-release tablet may be prescribed once or twice a day. Morphine sulfate rectal suppository prescriptions usually call for 10 mg to 20 mg every 4 hours as needed or as directed by a doctor. A doctor might prescribe 2.5 mg to 20 mg of morphine sulfate be injected into an IV every two to six hours as needed or through continuous infusion at up to 10 mg per hour. An intramuscular or subcutaneous injection prescription may allow for 2.5 mg to 20 mg of morphine sulfate every two to six hours as needed to through continuous infusion at up to 10 mg per hour. Morphine sulfate is also available through an epidural, with the usual initial dose for intermittent injection of 5 mg. If this dose provided inadequate pain control after one hour, additional epidural doses may be given in 1 mg to 2 mg increments, not to exceed a 10 mg total daily dose.

Take this medication with or without food. Swallow extended release tablets whole; do not crush, chew or break the tablet, which may result in a rush of medication entering the bloodstream. Morphine capsules may be opened, and the contents may be sprinkled into a tablespoon or two of applesauce. The patient should immediately swallow the entire dose of applesauce without chewing or sucking and then drink and entire glass of water to make sure no beads or pellets remain in the mouth. The mixture of applesauce and morphine sulfate beads or pellets should not be saved; use in its entirety or discard immediately.

If you miss a dose, take the missed dose as soon as possible. If it is nearly time to take another dose, skip the missed dose and resume your normal schedule. If you have trouble maintaining your schedule, or the prescribed dosage stops working to relieve your pain, notify the prescribing physician. Do not take extra doses in an effort to catch up on missed doses or to resolve stubborn pain.

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Action

Morphine sulfate works by stimulating opioid receptors in the central nervous system. This drug also causes respiratory depression, a condition where there is not enough air flow to perform the needed gas exchange. Morphine sulfate also causes peripheral dilation, slows down movement in the intestines, spasm of the sphincter which controls digestive juices and increases bladder tone. Morphine sulfate stimulates chemoreceptors in a way that causes vomiting. It takes 15 to 60 minutes for oral preparations of morphine sulfate to begin working. Pain relief typically lasts 3 to 7 hours. Morphine sulfate delivered through an epidural usually relieves pain within 6 to 30 minutes with pain relief lasting 16 to 24 hours from a single epidural injection. More About How Morphine Sulfate Works

Precautions

Do not take morphine sulfate if you are allergic to it or to any other opioid, such as codeine. An allergic reaction is a serious medical condition that can deteriorate rapidly into a medical emergency. Seek help immediately if you suspect an allergic reaction. Symptoms of an allergic reaction include hives, difficulty breathing and swelling of the face, lips, tongue or throat.

Do not drink alcohol while taking morphine sulfate. Check the labels of all food, beverage, prescription medications and over-the-counter preparations for alcohol. Ask your pharmacist for help if you are unsure.

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Warnings

Do not use morphine sulfate if you are hypersensitive to opioids. Tell the prescribing physician if you suffer from acute asthma or have recently had diarrhea caused by poisoning or toxins. Do not use this medication if you suffer from upper airway obstructions.

Do not use injectable morphine sulfate if you have arrhythmias or heart failure secondary to chronic lung disease. Injectable morphine is contraindicated for those with a history of brain tumor, acute alcoholism or delirium tremens, commonly known as DTs. Do not take injectable morphine sulfate if you have ever suffered from convulsions from epilepsy, tetanus or strychnine poisoning.

Immediate-release morphine sulfate oral solutions are contraindicated for patients who have experienced respiratory insufficiency, severe central nervous system depression, heart failure due to chronic lung disease or cardiac arrhythmias. Do not use this type of morphine sulfate if you have ever had head injuries, a brain tumor, increased intracranial or cerebrospinal pressure or convulsive disorders. This medication should not be used by patients who have acute alcoholism or DTs. This medication could cause complications in patients who may need abdominal surgery or have had certain types of abdominal surgery. Do not use immediate-release morphine sulfate if you have taken MAO inhibitors within the past 14 days; doing so may cause dangerous, even fatal, drug interactions.

Morphine sulfate crosses the placental membrane. This chemical is also found in the breast milk of women who took morphine sulfate. Do not breastfeed a baby while taking this medication. Tell the prescribing physician if you are pregnant or plan to become pregnant while taking this drug. Notify your doctor immediately if you become pregnant while taking morphine sulfate.

Quitting morphine sulfate suddenly may cause unpleasant withdrawal symptoms. Do not stop taking morphine sulfate abruptly unless directed to do so by a physician. Try weaning yourself from morphine sulfate by taking increasingly smaller doses further apart. Tell your doctor or seek out the help of a qualified rehabilitation clinic if withdrawal symptoms prevent you from quitting this medication.

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Drug Interactions

Morphine sulfate may interact with other drugs in unsafe or unfavorable ways. Give your doctor and pharmacist a complete and updated list of all your medications, including prescriptions, over-the-counter drugs and herbal remedies. Do not start or stop any medication while taking morphine sulfate without first talking with your doctor. Medications that may interact with morphine sulfate include:

  • Sleeping Pills.
  • Other Pain Medicines.
  • Anti-Nausea Medicines.
  • Tranquilizers.
  • Muscle Relaxants.
  • Antihistamines.
  • Anti-Anxiety Medicines.
  • Anti-Depressants.
  • Cimetidine (Tagamet).
  • Anticholinergic Medicines.

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Side effects

Patients have reported non-serious side effects after using morphine sulfate. Contact the prescribing physician if these common side effects become intolerable or if they don't go away on their own. Common side effects include:

  • Nausea.
  • Constipation.
  • Sleepiness.
  • Lightheadedness.
  • Dizziness.
  • Drowsiness.
  • Vomiting.
  • Sweating.

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Overdose

Overdose of morphine sulfate is a serious, potentially life-threatening event. If you suspect you or someone you know has taken an overdose of morphine sulfate, immediately call poison control center at 1-800-222-1222 or go to the closest emergency room. Overdose symptoms include:

  • Slow or Shallow Breathing.
  • Feeling Faint, Dizzy or Confused.
  • Any Other Unusual Symptoms

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Abuse

Morphine sulfate is one of the most widely abused of all drugs. Recreational users favor morphine because of the way it gets them high. Others may abuse morphine because they became addicted to this powerful opioid as part of a treatment for acute or chronic pain. Abusers can acquire morphine by filing bogus prescriptions, going to multiple doctors or by stealing from friends, family members, pharmacies or strangers. Morphine is also widely available on the streets.

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Withdrawal

Withdrawal is a predictable, normal physiological response to taking high doses of opioids or taking them for a long time. Your body goes through withdrawal because it has grown dependent on morphine to feel normal. Withdrawal symptoms can vary in intensity from person to person; withdrawal may be severe enough to prevent some people from quitting morphine. Withdrawal symptoms include:

  • Feeling Restless.
  • Tearing Eyes.
  • Runny Nose.
  • Yawning.
  • Sweating.
  • Chills.
  • Hair On Your Arms "Stands Up."
  • Muscle Aches.
  • Backache.
  • Dilated Pupils.
  • Feeling Irritable or Anxious.
  • Trouble Sleeping.
  • Nausea, Vomiting, Diarrhea.
  • Loss of Appetite.
  • Abdominal Cramps.

Detox

Dependence to morphine sulfate is a complex condition; you may need the help of qualified rehabilitation professionals. The most effective rehabilitative treatment programs address each aspect of the complicated syndrome of drug dependence, including overcoming withdrawal symptoms, detoxifiying your body and then addressing any social issues that contributed to your dependence on morphine. During the first phase of rehabilitation, physicians administer medication to remove the morphine from your body. Other medications ease your withdrawal symptoms. Once you are physically stabile, you can participate in counseling programs or other social services to address any issues that contributed to or are the result of your dependence on drugs, such as family problems or legal issues. Rapid detox is the most advanced, state-of-the-art, humane and extremely effective way to overcome withdrawal. During rapid detox, specially trained and highly qualified physicians administer anesthesia and sedatives along with detoxification medications. You sleep serenely through the withdrawal process, unaware of the unpleasant symptoms associated with withdrawal. When you awaken, you will have no memory of the withdrawal process. Learn More About Morphine Sulfate Detoxification Programs

Storage

Keep morphine sulfate preparations at room temperature. Do not expose to extreme heat or moisture. Do not store this medication in your bathroom. Keep this and all narcotic medications away from adults who might mistakenly or purposefully take this drug. Keep this and all medications out of the reach of children and pets. Do not share your morphine sulfate with anyone else, even if they have similar symptoms.

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Miscellaneous information

The manufacturers of oral solution of morphine sulfate, Roxane Laboratories, and the FDA notified healthcare professionals about serious adverse effects and even deaths resulting from overdose, especially when using the high-dose, 100 mg/5 ml oral solution. In most of these cases, overdoses were a result of prescribing errors due to unclear labeling. Improved product labeling and packaging intends to reduce these medication errors. Miscellaneous Information About Morphine Sulfate.