Morphine

Morphine sulfate is a prescription drug used to treat moderate to severe acute or chronic pain. It's sold under several brand names, including Roxanol, Kadian, and Avinza.

Morphine is part of a class of drugs called opiate (narcotic) analgesics, or opioid agonists, which block the transmission of pain signals to the brain by binding to nervous system proteins called opioid receptors.

Morphine is also sometimes prescribed "off label" to treat pain in hospitalized children.

The Food and Drug Administration (FDA) first approved morphine in 1941. Multiple companies, including King Pharmaceuticals, Hospria, and Roxane Laboratories, manufacture the drug under different brand names.

Morphine frequently pops up in the news because of accidental overdoses — lawsuits over fatal overdoses are generally directed at the pharmacies that made the drug or the clinics that prescribed it.

In 2008, KV Pharmaceutical Co. fired then-CEO and chairman Marc Hermelin for failing to take proper action to prevent the distribution of oversized versions of the company's Ethex morphine pills, some of which had up to double the indicated dosage.

In 2011, after Hermelin pleaded guilty to violating drug-labeling laws, he was sentenced to 30 days in jail and forced to pay nearly $2 million in fines.

Morphine Abuse and Withdrawal

As with other opioid agonists, morphine carries a risk of abuse, misuse, and addiction, particularly for people with a personal or family history of substance abuse.

Addiction often results in various drug-seeking tactics, such as calling or visiting emergency rooms near the end of office hours, continually "losing" prescriptions, and “doctor shopping,” or trying to obtain additional prescriptions from other physicians.

Even if you don't abuse morphine, you may become physically dependent on the drug and suffer withdrawal symptoms if you suddenly stop taking it.

Withdrawal symptoms include:

• Teary eyes and runny nose
• Irritability and anxiety
• Sweating and chills
• Restlessness, yawning, and difficulty falling asleep or staying asleep
• Back, muscle, or joint pain
• Nausea, vomiting, loss of appetite, diarrhea, and stomach cramps
• Weakness
• Quickened heartbeat and breathing

Morphine Warnings

You shouldn't use morphine if you have:

• A known sensitivity to morphine
• Respiratory depression (slowed breathing), bronchial asthma, or an abnormal amount of carbon dioxide in your body, and are in an unmonitored setting or without resuscitative equipment
• Paralytic ileus, an intestinal obstruction caused by paralyzed intestinal muscles

Morphine may cause respiratory depression. The risk of respiratory depression and other potentially fatal issues — including low blood pressure, profound sedation, coma, and death — increase when morphine is used in concert with central nervous system (CNS) depressants, such as sedatives, hypnotics, or other opioids.

The risk of respiratory depression with morphine is also greater for older people, people who are debilitated, or who already suffer from respiratory problems.

The oral solution of morphine (Roxanol) with the highest concentration (100 milligrams per 5 milliliters) should be taken only by people who are opioid tolerant or are used to the effects of opioids; the same is true for Avinza capsules containing 90 milligrams (mg) or more.

Morphine may cause severe low blood pressure in people who have low blood volume, anemia, or who were given general anesthetics or phenothiazines.

If you have a head injury or increased intracranial pressure, taking morphine may exaggerate the drug's respiratory depressant effects. It may also further increase intracranial pressure.

Using morphine when you have bile or pancreatic duct diseases may cause sphincter spasms and reduce biliary and pancreatic secretions.

Tell your doctor if you have or have ever had severe kidney or liver problems, low blood pressure, Addison's disease, hypothyroidism, prostate enlargement, seizures, difficulty swallowing, or urinary problems.

Pregnancy and Morphine

Morphine is an FDA Pregnancy Category C drug, meaning that animal studies have shown an "adverse" effect on the fetus, and harm to a woman's fetus cannot be ruled out.

Because of this, the drug should only be given to pregnant women if the potential benefits outweigh the potential risk.

Morphine should also not be given to women before delivery, or to nursing mothers, as it both crosses the placenta and is excreted in breast milk, causing potential harm to newborn and breastfeeding infants.

Morphine may interact with:

• CNS depressants
• Muscle relaxants
• Cimetidine (Tagamet)
• Monoamine oxidase inhibitors (MAOIs)
• Anticholinergics
• P-Glycoprotein (PGP) inhibitors
• Diuretics

Make sure to let your doctor know about any prescription, non-prescription, and over-the-counter (OTC) medications, illegal and recreational drugs, herbal remedies, and nutritional and dietary supplements you're taking.

Morphine and Alcohol

Drinking alcohol while taking morphine increases your risk of developing life-threatening health problems.

This is especially true if you're taking extended-release capsules such as Avinza, because alcohol can cause the morphine to be released too quickly. Biting or chewing these capsules, or regular capsules, can also deliver too much morphine at once.

Morphine and Other Interactions

Avoid driving or operating machinery while taking morphine. Children who are accidentally exposed to morphine may receive a fatal overdose of the drug.

Morphine is a prescription pain medication belonging to a group of drugs called opioid narcotics. Opoid narcotics bind to receptors throughout the body which works to relieve moderate to severe pain. 

Morphine is the active ingredient of a variety of medications found in many different forms, including tablets, extended-release tablets or capsules, oral solution, or injectable solution.

Extended-release forms are used for pain that is expected to persist for an extended period of time.

Rectal morphine comes as a suppository to insert in the rectum, usually every 4 hours.

Common side effects of morphine include constipation, nausea, itchiness, and sleepiness. Do not drink alcohol or any foods or medications containing alcohol while taking morphine as alcohol increases the risk that you will experience breathing problems or other serious, life-threatening side effects.

Before receiving this medication, tell your doctor if you:

• have severe asthma, trouble breathing, or other lung problems.
• have a bowel blockage or have narrowing of the stomach or intestines.
• have a history of head injury, seizures.
• have liver, kidney, thyroid, pancreas, or gallbladder problems.
• have problems urinating.
• are pregnant or planning to become pregnant. 
• are breastfeeding. 
• are taking prescription or over-the-counter medicines, vitamins, or herbal supplements.
• have a history of abuse of street or prescription drugs, alcohol addiction, or mental health problems.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For morphine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to morphine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of morphine in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of morphine in the elderly. However, elderly patients are more likely to have age-related lung, liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving morphine in order to avoid potentially serious side effects.

Pregnancy

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking morphine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using morphine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Nalmefene
• Naltrexone
• Safinamide

Using morphine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Abiraterone
• Acepromazine
• Alfentanil
• Almotriptan
• Alprazolam
• Alvimopan
• Amineptine
• Amiodarone
• Amisulpride
• Amitriptyline
• Amitriptylinoxide
• Amobarbital
• Amoxapine
• Amphetamine
• Anileridine
• Aripiprazole
• Asenapine
• Azithromycin
• Baclofen
• Benperidol
• Benzphetamine
• Bromazepam
• Bromopride
• Brompheniramine
• Buprenorphine
• Buspirone
• Butabarbital
• Butorphanol
• Captopril
• Carbamazepine
• Carbinoxamine
• Carisoprodol
• Carphenazine
• Carvedilol
• Chloral Hydrate
• Chlordiazepoxide
• Chlorpheniramine
• Chlorpromazine
• Chlorzoxazone
• Cimetidine
• Citalopram
• Clarithromycin
• Clobazam
• Clomipramine
• Clonazepam
• Clorazepate
• Clozapine
• Cobicistat
• Cocaine
• Codeine
• Conivaptan
• Cyclobenzaprine
• Cyclosporine
• Desipramine
• Desmopressin
• Desvenlafaxine
• Dexmedetomidine
• Dextroamphetamine
• Dextromethorphan
• Dezocine
• Diazepam
• Dibenzepin
• Dichloralphenazone
• Difenoxin
• Dihydrocodeine
• Diltiazem
• Diphenhydramine
• Diphenoxylate
• Dolasetron
• Donepezil
• Doxepin
• Doxorubicin
• Doxorubicin Hydrochloride Liposome
• Doxylamine
• Dronedarone
• Droperidol
• Duloxetine
• Eletriptan
• Enflurane
• Erythromycin
• Escitalopram
• Estazolam
• Eszopiclone
• Ethchlorvynol
• Ethopropazine
• Ethylmorphine
• Felodipine
• Fentanyl
• Flibanserin
• Fluoxetine
• Fluphenazine
• Flurazepam
• Fluspirilene
• Fluvoxamine
• Fospropofol
• Frovatriptan
• Furazolidone
• Granisetron
• Halazepam
• Haloperidol
• Halothane
• Hexobarbital
• Hydrocodone
• Hydromorphone
• Hydroxytryptophan
• Hydroxyzine
• Imipramine
• Iproniazid
• Isocarboxazid
• Isoflurane
• Itraconazole
• Ivacaftor
• Ketamine
• Ketobemidone
• Ketoconazole
• Levomilnacipran
• Levorphanol
• Linezolid
• Lisdexamfetamine
• Lithium
• Lofepramine
• Lopinavir
• Lorazepam
• Lorcaserin
• Loxapine
• Meclizine
• Melitracen
• Melperone
• Meperidine
• Mephobarbital
• Meprobamate
• Meptazinol
• Mesoridazine
• Metaxalone
• Methadone
• Methamphetamine
• Methdilazine
• Methocarbamol
• Methohexital
• Methotrimeprazine
• Methylene Blue
• Methylnaltrexone
• Midazolam
• Milnacipran
• Mirtazapine
• Moclobemide
• Molindone
• Moricizine
• Nalbuphine
• Nalorphine
• Naloxone
• Naratriptan
• Nefazodone
• Nialamide
• Nicomorphine
• Nilotinib
• Nitrazepam
• Nitrous Oxide
• Nortriptyline
• Olanzapine
• Ondansetron
• Opipramol
• Opium
• Opium Alkaloids
• Orphenadrine
• Oxazepam
• Oxycodone
• Oxymorphone
• Palonosetron
• Papaveretum
• Paregoric
• Paroxetine
• Pentazocine
• Pentobarbital
• Perampanel
• Perazine
• Periciazine
• Perphenazine
• Phenelzine
• Phenobarbital
• Pimozide
• Piperacetazine
• Pipotiazine
• Piritramide
• Prazepam
• Primidone
• Procarbazine
• Prochlorperazine
• Promazine
• Promethazine
• Propofol
• Protriptyline
• Quazepam
• Quercetin
• Quetiapine
• Quinidine
• Ramelteon
• Ranolazine
• Rasagiline
• Remifentanil
• Remoxipride
• Ritonavir
• Rizatriptan
• Samidorphan
• Secobarbital
• Selegiline
• Sertindole
• Sertraline
• Sibutramine
• Simeprevir
• Sodium Oxybate
• St John's Wort
• Sufentanil
• Sulpiride
• Sumatriptan
• Sunitinib
• Suvorexant
• Tapentadol
• Telaprevir
• Temazepam
• Thiethylperazine
• Thiopental
• Thiopropazate
• Thioridazine
• Tianeptine
• Ticagrelor
• Tilidine
• Tizanidine
• Tocophersolan
• Tolonium Chloride
• Topiramate
• Tramadol
• Tranylcypromine
• Trazodone
• Triazolam
• Trifluoperazine
• Trifluperidol
• Triflupromazine
• Trimeprazine
• Trimipramine
• Tryptophan
• Venlafaxine
• Verapamil
• Vilazodone
• Vortioxetine
• Zaleplon
• Ziprasidone
• Zolmitriptan
• Zolpidem
• Zopiclone
• Zotepine

Using morphine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Esmolol
• Gabapentin
• Gabapentin Enacarbil
• Rifampin
• Somatostatin
• Yohimbine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using morphine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use morphine, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of morphine. Make sure you tell your doctor if you have any other medical problems, especially:

• Addison disease (adrenal gland problem) or
• Alcohol abuse, or history of or
• Brain tumor, history of or
• Chronic obstructive pulmonary disease (COPD) or
• Cor pulmonale (serious heart condition) or
• Depression, history of or
• Drug dependence, especially with narcotics, or history of or
• Enlarged prostate (BPH, prostatic hypertrophy) or
• Gallbladder disease or gallstones or
• Head injuries, history of or
• Heart disease or
• Hypothyroidism (an underactive thyroid) or
• Hypovolemia (low blood volume) or
• Increased pressure in the head or
• Kyphoscoliosis (curvature of the spine with breathing problems) or
• Mental health problems, history of or
• Problems with passing urine or
• Stomach or bowel problems (eg, blockage) or
• Trouble swallowing or
• Weakened physical condition—Use with caution. May increase risk for more serious side effects.

• Hypotension (low blood pressure) or
• Pancreatitis (inflammation or swelling of the pancreas) or
• Seizures, history of—Use with caution. May make these conditions worse.

• Kidney disease or
• Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

• Lung or breathing problems, severe or
• Stomach or bowel blockage (eg, paralytic ileus)—Should not be used in patients with these conditions.

Take morphine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important for elderly patients, who may be more sensitive to the effects of pain medicines. If too much of morphine is taken for a long time, it may become habit-forming (causing mental or physical dependence).

morphine comes with a Medication Guide and patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

Avinza® is taken every 24 hours. Kadian® is taken every 12 or 24 hours at the same time each day. Morphabond™ is taken every 12 hours. Arymo™ ER is taken every 8 or 12 hours.

You may take morphine with or without food.

Morphine extended-release capsules and tablets should only be used by patients who have already been taking narcotic pain medicines, also called opioids. These patients are called opioid-tolerant. If you are uncertain whether or not you are opioid-tolerant, check with your doctor before using morphine.

Swallow the extended-release capsules and tablets whole. Do not crush, break, dissolve, or chew them. Do not use extended-release tablets that are broken.

If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of applesauce. Stir this mixture well and swallow it right away without chewing. Do not receive morphine through a nasogastric tube.

While taking the extended-release tablet, part of the tablet may pass into your stool. This is normal and nothing to worry about.

Morphine extended-release capsules or tablets work differently from the regular morphine oral solution or tablets, even at the same dose. Do not switch from one brand or form to the other unless your doctor tells you to.

Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

Dosing

The dose of morphine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of morphine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (extended-release capsules):
  • For moderate to severe pain:
    • Adults—
      • The total amount of milligrams (mg) per day is determined by your doctor. Your doctor may adjust your dose if needed.
      • Avinza®: The capsule is given every 24 hours.
      • Kadian®: The capsule is given every 12 or 24 hours.
    • Children—Use and dose must be determined by your doctor.
• For oral dosage form (extended-release tablets):
  • For moderate to severe pain:
    • Adults—
      • The total amount of milligrams (mg) per day is determined by your doctor. Your doctor may adjust your dose if needed.
      • Arymo™ ER: The tablet is given every 8 or 12 hours.
      • Morphine sulfate: The tablet is given every 8 or 12 hours.
      • Morphabond™: The tablet is given every 12 hours.
      • MS Contin®: The tablet is given every 8 or 12 hours.
    • Children—Use and dose must be determined by your doctor.
• For oral dosage form (solution):
  • For moderate to severe pain:
    • Adults—10 to 20 milligrams (mg) every 4 hours as needed. Your doctor may adjust your dose if needed.
    • Children—Use and dose must be determined by your doctor.
• For oral dosage form (tablets):
  • For moderate to severe pain:
    • Adults—15 to 30 milligrams (mg) every 4 hours as needed. Your doctor may adjust your dose if needed.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of morphine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose of Arymo™ ER, Avinza®, Kadian®, Morphabond™, or MS Contin®, skip the missed dose and take your next dose at your usual time the next day. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Morphine can cause serious unwanted effects if taken by adults, children, or pets who are not used to strong narcotic pain medicines. Make sure you store the medicine in a safe and secure place to prevent others from getting it.