Morphine : Strong Opioids

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Pain Medications : Strong Opioids

Last Updated: Jul 1, 2011 - 8:08:19 PM

Morphine
By Steele
Jan 15, 2000 - 9:35:00 PM

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Morphine (INN) (MS Contin, MSIR, Avinza, Kadian, Oramorph, Roxanol, Kapanol) is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was discovered in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more widely used after the invention of the hypodermic needle in 1857. It took its name from the Greek God of dreams Morpheus.

Morphine is available as long-acting capsules or tablets. These capsules or tablets contain enough morphine to relieve pain for 12 or 24 hours and are designed to release the medication slowly over that period of time. It is very important not to split, chew, or crush these tablets or capsules and not to dissolve the beads contained in the capsules in any liquid before you swallow them. This would release all of the medication into your body at once and could cause serious health problems or death.

If you are taking Oramorph SR or MS Contin brand long-acting tablets or Avinza or Kadian brand long-acting capsules, you should swallow the tablets or capsules whole. If you are unable to swallow the capsules, you can carefully open a capsule, sprinkle all of the beads that it contains on a spoonful of cold or room temperature applesauce, and swallow the entire mixture immediately without chewing or crushing the beads. Then rinse your mouth with a little water and swallow the water to be sure that you have swallowed all the medication. Do not save mixtures of medication and applesauce for later.

If you are taking Avinza brand long-acting capsules, you should not drink any drinks that contain alcohol or take any prescription or nonprescription medications that contain alcohol. Ask your doctor or pharmacist or check the list of ingredients if you do not know if a medication contains alcohol. Alcohol may cause the morphine in Avinza^® brand long-acting capsules to be released in your body too quickly, causing serious health problems or death.

Morphine is the most abundant alkaloid found in opium, the dried sap (latex) derived from shallowly slicing the unripe seedpods of the opium, or common or edible, poppy, Papaver somniferum. Morphine was the first active principle purified from a plant source and is one of at least 50 alkaloids of several different types present in opium, Poppy Straw Concentrate, and other poppy derivatives. Morphine is generally 8 to 17 per cent of the dry weight of opium, although specially-bred cultivars reach 26 per cent or produce little morphine at all, under 1 per cent, perhaps down to 0.04 per cent. The latter varieties, including the 'Przemko' and 'Norman' cultivars of the opium poppy, are used to produce two other alkaloids, thebaine and oripavine, which are used in the manufacture of semi-synthetic and synthetic opioids like oxycodone and etorphine and some other types of drugs.(P. bracteatum) does not contain morphine or codeine, or other narcotic phenanthrene-type, alkaloids. This species is rather a source of thebaine. Occurrence of morphine in other papaverales and papaveraceae , as well as in some species of hops and mulberry trees has not been confirmed. Morphine is produced most predominantly early in the life cycle of the plant. Past the optimum point for extraction, various processes in the plant produce codeine, thebaine, and in some cases negligable amounts of hydromorphone, dihydromorphine, dihydrocodeine, tetrahydrothebaine, and hydrocodone (these compounds are rather synthesized from thebaine and oripavine). The human body produces endorphines, which are neuropeptides, with similar effects.

In clinical medicine, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve severe or agonizing pain and suffering. Like other opioids, e.g. oxycodone (OxyContin, Percocet, Percodan), hydromorphone (Dilaudid, Palladone), and diacetylmorphine (heroin), morphine acts directly on the central nervous system (CNS) to relieve pain. Unlike the opioids, Morphine is an opiate and a natural product. Morphine has a high potential for addiction; tolerance and psychological dependence develop rapidly, although Physiological dependence may take several months to develop.

Why is this medication prescribed?

Morphine is used to relieve moderate to severe pain. Morphine long-acting tablets and capsules are only used by patients who are expected to need medication to relieve moderate to severe pain around-the-clock for longer than a few days. Morphine is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the body senses pain.

How should this medicine be used?

Morphine comes as a tablet, a solution (liquid), a controlled- or extended-release (long-acting) tablet, and a controlled- or sustained-release (long-acting) capsule all to take by mouth. The regular tablet and liquid usually are taken every 4 hours. The long-acting tablet is usually taken every 8 to 12 hours. Kadian brand long-acting capsules are usually taken with or without food every 12 hours or every 24 hours. Avinza brand long-acting capsules are usually taken once a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

If you are taking morphine solution, use the spoon or dropper that comes with the medication to measure your dose. Be sure that you know how many milliliters of the solution you should take. Ask your pharmacist if you have any questions about how much medication you should take or how to use the spoon or dropper.

If you are taking Kadian brand long-acting capsules and you have a gastrostomy tube (surgically inserted feeding tube), ask your doctor or pharmacist how to administer the medication through your tube.

Your doctor may start you on a low dose of morphine and gradually increase your dose until your pain is controlled. Your doctor may adjust your dose at any time during your treatment if your pain is not controlled. If you feel that your pain is not controlled, call your doctor. Do not change the dose of your medication without talking to your doctor.

Morphine can be habit-forming. Take morphine exactly as directed. Do not take a larger dose, take it more often, or take it for a longer period of time or in a different way than prescribed by your doctor.

Do not stop taking morphine without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop taking morphine, you may experience withdrawal symptoms such as anxiety; sweating; difficulty falling asleep or staying asleep; chills; shaking of a part of your body that you cannot control; nausea; diarrhea; runny nose, sneezing or coughing; hair on your skin standing on end; or hallucinating (seeing things or hearing voices that do not exist).

What special precautions should I follow?

Before taking morphine,

tell your doctor and pharmacist if you are allergic to morphine, any other medications, or any of the inactive ingredients in the type of morphine tablets, capsules, or liquid you plan to take. Ask your pharmacist for a list of the inactive ingredients.
tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin);antidepressants such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); antihistamines (found in cold and allergy medications); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); buprenorphine (Subutex, in Suboxone); butorphanol (Stadol); cimetidine (Tagamet); diuretics ('water pills'); medications for anxiety, mental illness, pain, seizures, or nausea; muscle relaxants; nalbuphine (Nubain); pentazocine (Talwin, in Talacen); sedatives; sleeping pills; and tranquilizers. Also tell your doctor if you are taking any of the following medications or if you have stopped taking them within the past 2 weeks: monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), phenelzine (Nardil), procarbazine (Matulane), selegiline (Eldepryl), and tranylcypromine (Parnate). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have ever had major surgery. Also tell your doctor if you have or have ever had a head injury; a brain tumor; seizures; mental illness; difficulty swallowing; lung disease such as asthma, chronic obstructive pulmonary disease (COPD; a group of diseases that cause gradual loss of lung function), or other breathing problems; prostatic hypertrophy (enlargement of a male reproductive gland); urinary problems; low blood pressure; irregular heartbeat; Addison's disease (condition in which the body does not make enough of certain natural substances); or liver, kidney, pancreatic, intestinal, or gallbladder disease.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking morphine, call your doctor.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking morphine.
you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
talk to your doctor about the safe use of alcohol while you are taking this medication.
you should know that morphine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

What side effects can this medication cause?

Morphine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

dizziness
lightheadedness
drowsiness
nausea
vomiting
constipation
diarrhea
loss of appetite
weight loss
changes in ability to taste food
dry mouth
sweating
weakness
headache
agitation
nervousness
mood changes
confusion
difficulty falling asleep or staying asleep
stiff muscles
shaking of a part of your body that you cannot control
double vision
red eyes
small pupils (black circles in the middle of the eyes
eye movements that you cannot control
chills
flu symptoms
decreased sexual desire or ability
difficulty urinating or pain when urinating

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

slow, shallow, or irregular breathing
blue or purple color to the skin
fast or slow heartbeat
seizures
hallucinations (seeing things or hearing voices that do not exist)
blurred vision
fainting
hives
rash
itching
tightness in the throat
difficulty swallowing
swelling of the arms, hands, feet, ankles, or lower legs

Morphine may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

slow, shallow, or irregular breathing
sleepiness
loss of consciousness
limp muscles
cold, clammy skin
small pupils
slow heartbeat
blurred vision
nausea
fainting

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. This prescription is not refillable. If you are taking morphine to control your pain on a long term basis, be sure to schedule appointments with your doctor so that you do not run out of medication. If you are taking morphine on a short term basis, call your doctor if you continue to experience pain after you finish the medication.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

Avinza^®
Kadian^®

MS Contin^®
Oramorph^® SR

Roxanol^®
Roxanol^®-T

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