Morphine Oral - SUSTAINED - ACTION CAPSULE

Warnings  
The capsules of this medication must be swallowed whole or their contents sprinkled on applesauce. The capsules and their contents must never be crushed, chewed, or dissolved. Also, never drink alcohol or use any medicines that contain alcohol while taking this medication. Crushing/chewing the medication or using alcohol may result in the rapid release of all of the medication at once, which may be fatal. (See also How to Use and Drug Interactions.)

Uses 
See also the Warning section.

This medication is used to relieve moderate to severe pain that requires strong, long-lasting narcotic pain medications for more than a few days. It is used when pain cannot be relieved by other pain relievers. This medication should not be used to relieve pain after surgery or pain that lasts for only a short time.

This medication is a long-acting form of a narcotic pain reliever (opiate-type). It works on certain centers in the brain to give you pain relief.

How to use Morphine Oral

See also the Warning section.

Take this medication by mouth with or without food, usually once or twice daily or as directed by your doctor.

If nausea occurs, consult your doctor or pharmacist about ways to reduce it (e.g., antihistamines, lying down for 1-2 hours with as little head movement as possible).

Swallow the capsules whole. Do not crush, chew, or dissolve the capsules or their contents. Doing so can destroy the long action of the drug and may lead to the release of a very high (possibly fatal) dose of drug all at once.

If you have trouble swallowing the capsule, the capsule may be opened and its contents carefully sprinkled on a spoonful of soft, cool applesauce just before you take it. Swallow the drug/food mixture immediately without chewing, then rinse your mouth and swallow the rinse liquid to make sure that you have swallowed all of the medicine. Do not chew the mixture or prepare a supply for future use.

If giving this medication through a gastrostomy tube, first flush the tube with water to make sure it is wet. Open the capsule, sprinkle the entire contents into a container, and add 2 teaspoons (10 milliliters) of water. Use a swirling motion to pour the water/pellet mixture into the gastrostomy tube through a fitted funnel. Use more water to rinse the container, the funnel, and the tube to make sure all the medication passes through the tube.

Do not give this medication through a nasogastric tube.

The dosage is based on your medical condition, response to therapy, and previous use of narcotics. Use this medication exactly as prescribed.

If so directed by your doctor, you may take short-acting (immediate-release) narcotic pain medications (e.g., morphine elixir, codeine) for attacks of severe pain. Also, follow your doctor's instructions for the safe use of non-narcotic pain relievers (e.g., acetaminophen, ibuprofen). If you have been using other long-acting pain medications regularly, ask your doctor if you should continue or stop them. Follow your doctor's instructions carefully.

This medication may cause dependence, especially if it has been used regularly for a long time or if it has been used in high doses. In such cases, if you suddenly stop this drug, withdrawal reactions may occur. Such reactions can include trouble sleeping, sweating, widened pupils, runny nose, watering eyes, irritability, weakness, muscle aches/twitching/cramps, stomach cramps, hot/cold flashes, sneezing, vomiting, diarrhea, rapid breathing, fast heartbeat, and fever. Withdrawal symptoms may worsen over the first 3 days. Most symptoms will disappear over the next 2 weeks. Some withdrawal symptoms, such as trouble sleeping, irritability, and muscle aches, may last 2 to 6 months. Report any such reactions to your doctor immediately. When stopping long-term, regular treatment with this drug, gradually reducing the dosage as directed will help prevent withdrawal reactions. Consult your doctor or pharmacist for more details.

Although it is very unlikely to occur, this medication can also result in abnormal drug-seeking behavior (addiction/habit-forming). Do not increase your dose, take it more frequently or use it for a longer time than prescribed. Properly stop the medication when so directed. This will lessen the chances of becoming addicted.

When used for an extended period, this medication may not work as well and may require different dosing. Talk with your doctor if this medication stops working well.

Inform your doctor if your pain persists or worsens.

Before taking this drug, tell your doctor or pharmacist if you are allergic to it; or to other narcotic pain relievers (e.g., codeine, hydromorphone); or if you have any other allergies.

This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: severe breathing problems (e.g., respiratory depression, hypercapnia, acute/severe asthma), certain bowel problems (e.g., paralytic ileus, bowel obstruction, diarrhea), intoxication with medications which cause drowsiness or slow/shallow breathing (alcohol, tranquilizers/sedatives), pain from a recent scorpion sting.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: difficulty urinating (e.g., due to enlarged prostate, urethral stricture), personal or family history of regular alcohol/drug abuse, lung disease, kidney disease, liver disease, low blood pressure, gallbladder/biliary tract problems, pancreatitis, certain brain disorders (e.g., brain tumor, increased intracranial pressure, coma), head injury, seizures, slow/irregular heartbeat, adrenal gland problems (e.g., Addison's disease), mental/mood conditions (e.g., toxic psychosis), a certain spine problem (kyphoscoliosis), recent surgery, underactive thyroid (hypothyroidism), inability to swallow, severe loss of body water (dehydration), severe obesity, stomach problems of unknown cause.

This drug may make you dizzy or drowsy or cause blurred vision. Use caution while engaging in activities requiring alertness or clear vision such as driving or using machinery. This is especially important when your dose has been increased.

To minimize dizziness and lightheadedness, get up slowly when rising from a seated or lying position.

Before having surgery, tell your doctor or dentist that you are taking this medication.

The contents of the capsules must not be injected. Serious lung/heart problems and damage to your tissues/skin may occur. There is also a risk of receiving a fatal dose of the medication.

The elderly may be more sensitive to the effects of this drug, especially slow/shallow breathing and drowsiness.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Tell your doctor immediately if you are pregnant or think you may be pregnant. This medication should not be started near or at the time of delivery because of possible problems in the newborn (e.g., slow/shallow breathing). If prescribed, follow your doctor's instructions closely and do not suddenly stop taking this drug. Infants born to mothers who have been using this medication for an extended time may have withdrawal symptoms such as irritability, abnormal/persistent crying, vomiting, or diarrhea. Tell the doctor immediately if you notice any of these symptoms in your newborn.

This medication passes into breast milk. Consult your doctor before breast-feeding.

Overdose

If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: slow/shallow breathing, cold/clammy skin, limp muscles, pinpoint pupils, loss of consciousness.

NOTES:

Do not share this medication with others. It is against the law.

This medication has been prescribed for your current condition only. Do not use it later for other pain-related conditions unless told to do so by your doctor. A different medication may be necessary in those cases.

When you no longer need this medication, flush any remaining capsules down the toilet.

MISSED DOSE:

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE:

Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.

Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product. 

Nausea, vomiting, constipation, lightheadedness, dizziness, drowsiness, stomach upset, face flushing, red eyes, dry mouth, decreased appetite, trouble sleeping, and increased sweating may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. If you become constipated while using this drug, consult your pharmacist for help in selecting a laxative (stimulant-type) and stool softener.

Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: slow/shallow breathing, difficulty urinating, shaking (tremor), severe stomach pain, severe constipation, severe vomiting, fainting, muscle stiffness, decreased sexual desire, mental/mood changes (e.g., agitation, depression, unusual elevated mood, hallucinations), vision changes, fast/slow/irregular heartbeat, swelling of the feet/ankles, trouble swallowing, tingling of the hands/feet, severe headaches.

Tell your doctor immediately if any of these rare but very serious side effects occur: easy bruising/bleeding, signs of infection (e.g., fever, persistent sore throat), seizures.

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching, swelling, severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

See also the Warning section.

Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop or change the dosage of any medicine before checking with them first.

This drug should not be used with the following medications because very serious interactions may occur: mixed opioid agonists/antagonists (e.g., buprenorphine, butorphanol, nalbuphine, pentazocine), naltrexone.

Do not drink alcoholic beverages or take prescription or nonprescription medications that contain alcohol while you are taking this medication. Alcohol may cause too much morphine to be released from the medication at one time, resulting in a very high (possibly fatal) dose of drug. Consult your pharmacist if you are unsure if any medications you use contain alcohol.

Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: amphetamines, water pills (diuretics such as furosemide), drugs affecting liver enzymes that remove morphine from your body (e.g., cimetidine, rifamycins including rifampin).

Tell your doctor or pharmacist if you also take drugs that cause drowsiness, slow your breathing, or lower your blood pressure such as: certain antihistamines (e.g., diphenhydramine), anti-seizure drugs (e.g., carbamazepine), medicine for sleep or anxiety (e.g., alprazolam, diazepam, zolpidem), muscle relaxants, narcotic pain relievers (e.g., codeine), psychiatric medicines (e.g., chlorpromazine, risperidone, amitriptyline, trazodone).

Check the labels on all your medicines (e.g., cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about the safe use of those products.

This product can affect the results of certain lab tests (e.g., amylase, lipase). Make sure laboratory personnel and all your doctors know you use this drug.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.