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Morphine Suspension

30/06/10

Generic Name: Morphine (MOR-feen)
Brand Name: DepoDur

Morphine Suspension is used for:

Treating pain following surgery. It may also be used for other conditions as determined by your doctor.

Morphine Suspension is a narcotic pain reliever. It works in the brain to decrease pain. It may also affect other body systems (eg, breathing and circulatory systems) at higher doses.

Do NOT use Morphine Suspension if:

you are allergic to any ingredient in Morphine Suspension
you have severe diarrhea, bowel problems caused by antibiotics or food poisoning, a blockage of your stomach or bowel, or certain other severe bowel problems (eg, bowel paralysis)
you have difficult or slowed breathing, severely decreased blood circulation (circulatory shock), a recent head injury, growths in the brain (eg, tumors), or increased pressure in the brain
if you have severe asthma, or if you are having an asthma attack
you are taking a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) or if you have taken an MAOI within the past 14 days
you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Morphine Suspension:

Some medical conditions may interact with Morphine Suspension. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a history of lung or breathing problems (eg, asthma, emphysema, bronchitis, chronic obstructive pulmonary disease [COPD]), sleep apnea (you stop breathing when you sleep), curvature of the spine (eg, kyphoscoliosis), heart problems (eg, cor pulmonale), low blood pressure, dehydration, or low blood volume
if you have liver problems, kidney problems, adrenal gland problems (eg, Addison disease), an underactive thyroid, a blockage of your bladder, an enlarged prostate, or trouble urinating
if you have a history of bowel blockage or other stomach or bowel problems (eg, inflammation), pancreas or gallbladder problems, or recent stomach or bowel surgery
if you have severe drowsiness or a history of seizures (eg, epilepsy)
if you drink alcohol regularly, have symptoms of alcohol withdrawal, or have a history of suicidal thoughts or attempts
if you have a personal or family history of mental or mood problems, alcohol abuse, or other substance abuse or dependence
if you are in poor health or are overweight

Some MEDICINES MAY INTERACT with Morphine Suspension. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antiemetics (eg, metoclopramide), phenothiazines (eg, chlorpromazine), sleeping medicines (eg, zolpidem), or tranquilizers (eg, olanzapine) because the risk of breathing problems, low blood pressure, severe drowsiness, or coma may be increased
Barbiturate anesthetics (eg, thiopental), cimetidine, MAOIs (eg, phenelzine), muscle relaxants (eg, carisoprodol), or sodium oxybate (GHB) because the risk of confusion, severe drowsiness, severe breathing problems, and coma may be increased
Mixed narcotic agonists/antagonists (eg, pentazocine), naltrexone, or rifampin because they may decrease Morphine Suspension’s effectiveness
Diuretics (eg, furosemide, hydrochlorothiazide) or trovafloxacin because their effectiveness may be decreased by Morphine Suspension

This may not be a complete list of all interactions that may occur. Ask your health care provider if Morphine Suspension may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Morphine Suspension:

Use Morphine Suspension as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Morphine Suspension is usually given as an injection at your doctor’s office, hospital, or clinic.
If you miss a dose of Morphine Suspension contact your doctor.

Ask your health care provider any questions you may have about how to use Morphine Suspension.

Important safety information:

Morphine Suspension may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Morphine Suspension with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Do not drink alcohol while you are using Morphine Suspension.
Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Morphine Suspension; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
Morphine Suspension may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
Tell your doctor or dentist that you received Morphine Suspension before you have any medical or dental care, emergency care, or surgery.
Lab tests, including liver function, kidney function, lung function, and complete blood cell counts, may be performed while you use Morphine Suspension. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Use Morphine Suspension with caution in the ELDERLY; they may be more sensitive to its effects, especially severe breathing problems.
Morphine Suspension should not be used in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Morphine Suspension while you are pregnant. Morphine Suspension is found in breast milk. Check with your doctor to see whether or not you should breast-feed within 48 hours after receiving Morphine Suspension.

When used for long periods of time or at high doses, Morphine Suspension may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Morphine Suspension stops working well. Do not take more than prescribed.

Some people who use Morphine Suspension for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction.

If you stop taking Morphine Suspension suddenly, you may have WITHDRAWAL symptoms. These may include anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.

Possible side effects of Morphine Suspension:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; dizziness; drowsiness; headache; lightheadedness; nausea; vomiting; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; delirium; difficulty urinating; disorientation; fainting; fast, slow, or irregular heartbeat; fever; flushing of the face; hallucinations; mood or mental changes; numbness or tingling; seizures; severe dizziness or lightheadedness; severe drowsiness; severe or persistent vomiting or constipation, shortness of breath; slowed or difficult breathing; tremor; trouble sleeping; unusual sweating; vision changes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include cold and clammy skin; convulsions; deep sleep; dizziness; lightheadedness; loss of consciousness; severe drowsiness; slowed breathing; slowed heartbeat.

Proper storage of Morphine Suspension:

Morphine Suspension is usually handled and stored by a health care provider. If you are using Morphine Suspension at home, store Morphine Suspension as directed by your pharmacist or health care provider.

General information:

If you have any questions about Morphine Suspension, please talk with your doctor, pharmacist, or other health care provider.
Morphine Suspension is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Morphine Suspension. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: May 5, 2010

Database Edition 10.2.1.002

M,Med-facts

Comments (0)

Morphine Soluble Tablets

30/06/10

Generic Name: Morphine (MOR-feen)
Brand Name: Generic only. No brands available.

Morphine Soluble Tablets are used for:

Treating moderate to severe pain. It may also be used before surgery to aid sedation and anesthesia.

Morphine Soluble Tablets are a narcotic pain reliever. It works by dulling the pain perception center in the brain. It may also affect other body systems (eg, respiratory and circulatory systems) at higher doses.

Do NOT use Morphine Soluble Tablets if:

you are allergic to any ingredient in Morphine Soluble Tablets
you have severe diarrhea caused by antibiotic use
you are taking sodium oxybate (GHB)
you have slowed breathing or are having an asthma attack
you are having a seizure

Contact your doctor or health care provider right away if any of these apply to you.

Before using Morphine Soluble Tablets:

Some medical conditions may interact with Morphine Soluble Tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to any morphine-related medicine (eg, codeine)
if you have a history of alcohol or drug abuse or dependence or suicidal thoughts or actions
if you have a history of lung or breathing problems (eg, asthma, chronic obstructive pulmonary disease [COPD], sleep apnea) or low blood oxygen levels
if you have severe drowsiness, increased pressure in the head, recent head injury, growths in the brain, or a history of seizures
if you have trouble urinating, urinary blockage, or a history of kidney or liver problems; heart problems (eg, fast or irregular heartbeat); underactive thyroid; enlarged prostate; endocrine problems (eg, Addison disease); curvature of the spine (scoliosis); or seizures
if you have low blood pressure, low blood volume, stomach or intestinal problems (eg, blockage, inflammatory bowel disease, severe or chronic constipation), or have had stomach or intestinal surgery

Some MEDICINES MAY INTERACT with Morphine Soluble Tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

Phenothiazines (eg, chlorpromazine) because the risk of low blood pressure may be increased
Fluoxetine, naltrexone, narcotic agonists/antagonists (eg, pentazocine), rifampin, or risperidone because they may decrease Morphine Soluble Tablets’s effectiveness
Barbiturate anesthetics (eg, thiopental), cimetidine, ketorolac, sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because side effects (eg, disorientation, respiratory depression, seizures) may occur
Mexiletine or trovafloxacin because their effectiveness may be decreased by Morphine Soluble Tablets

This may not be a complete list of all interactions that may occur. Ask your health care provider if Morphine Soluble Tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Morphine Soluble Tablets:

Use Morphine Soluble Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Do NOT take Morphine Soluble Tablets by mouth. Morphine Soluble Tablets are intended to be dissolved for injection.
Morphine Soluble Tablets are usually given as an injection at your doctor’s office, hospital, or clinic. If you will be using Morphine Soluble Tablets at home, a health care provider will teach you how to use it. Be sure you understand how to use Morphine Soluble Tablets. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
Do not use Morphine Soluble Tablets if it is cloudy or discolored, or contains particles after mixing. Do not use Morphine Soluble Tablets if the solution is darker than pale yellow.
Take Morphine Soluble Tablets on a regular schedule to get the most benefit from it. It is more effective in preventing pain than in treating pain after it occurs.
Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
If you miss a dose of Morphine Soluble Tablets and you are using it regularly, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once. Contact your doctor if you are unsure what to do if you miss a dose of Morphine Soluble Tablets.

Ask your health care provider any questions you may have about how to use Morphine Soluble Tablets.

Important safety information:

Morphine Soluble Tablets may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Morphine Soluble Tablets with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Do not drink alcohol while you are using Morphine Soluble Tablets.
Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Morphine Soluble Tablets; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
Morphine Soluble Tablets may cause constipation. Using a stool softener or fiber laxative may help decrease this effect.
The risk of Morphine Soluble Tablets becoming habit-forming may be greater if you take it in high doses or for a long time. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
Tell your doctor or dentist that you take Morphine Soluble Tablets before you receive any medical or dental care, emergency care, or surgery.
Do not take Morphine Soluble Tablets if you have had a severe allergic reaction to morphine or hydromorphone (eg, MS Contin, Roxanol, Dilaudid). If you have a question about whether you are allergic to Morphine Soluble Tablets or if a certain medicine contains morphine or hydromorphone, contact your doctor or pharmacist.
Lab tests, including liver function, kidney function, lung function, and complete blood cell counts, may be performed while you use Morphine Soluble Tablets. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Use Morphine Soluble Tablets with caution in the ELDERLY; they may be more sensitive to its effects.
Morphine Soluble Tablets should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Morphine Soluble Tablets while you are pregnant. Morphine Soluble Tablets are found in breast milk. If you are or will be breast-feeding while you use Morphine Soluble Tablets, check with your doctor. Discuss any possible risks to your baby.

When used for long periods of time or at high doses, Morphine Soluble Tablets may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Morphine Soluble Tablets stops working well. Do not take more than prescribed.

Some people who use Morphine Soluble Tablets for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction. If you stop taking Morphine Soluble Tablets suddenly, you may have WITHDRAWAL symptoms. These may include anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.

Possible side effects of Morphine Soluble Tablets:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; dizziness; drowsiness; exaggerated sense of well-being; headache; lightheadedness; nausea; restless mood; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue); excessive drowsiness; hallucinations; pounding in the chest; seizures; shock; shortness of breath; sudden chest pain; unusual or excessive sweating.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include cold, clammy, or blue skin; convulsions; deep sleep; limp muscles; loss of consciousness; low body temperature; severe dizziness, drowsiness, or lightheadedness; slowed breathing; slowed heartbeat.

Proper storage of Morphine Soluble Tablets:

Store Morphine Soluble Tablets between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Morphine Soluble Tablets out of the reach of children and away from pets.

General information:

If you have any questions about Morphine Soluble Tablets, please talk with your doctor, pharmacist, or other health care provider.
Morphine Soluble Tablets are to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Morphine Soluble Tablets. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: May 5, 2010

Database Edition 10.2.1.002

M,Med-facts

Comments (0)

Morphine Extended-Release Capsules

30/06/10

Generic Name: Morphine (MOR-feen)
Brand Name: Kadian

Morphine Extended-Release Capsules contains morphine, a narcotic pain medicine. Tell your doctor if you have a history of alcohol or other substance abuse or dependence before you use Morphine Extended-Release Capsules.

Morphine Extended-Release Capsules are used to treat constant (around-the-clock), moderate to severe pain that is expected to last for an extended amount of time. Morphine Extended-Release Capsules are not for patients who only need occasional or “as-needed” pain relief.

Do not use Morphine Extended-Release Capsules if you have not already been taking other prescription narcotic pain medicines (eg, morphine, codeine) on a regular schedule. Serious and sometimes fatal breathing problems can occur if you are not already tolerant to high doses of narcotic medicines. Seek immediate medical attention if you develop slow, shallow, or difficult breathing while you take Morphine Extended-Release Capsules.

Swallow Morphine Extended-Release Capsules whole. If you cannot swallow the medicine whole, you may open the capsule and sprinkle the contents on a small amount of applesauce. Swallow the mixture right away. Do not chew, crush, or dissolve the pellets before swallowing them. Doing so may cause the medicine to be absorbed into the body too quickly. This could result in a very serious and possibly fatal overdose.

Morphine Extended-Release Capsules are used for:

Treating and preventing moderate to severe pain when a continuous, around-the-clock opioid pain reliever is needed over an extended period of time.

Morphine Extended-Release Capsules are a narcotic pain reliever. It works by binding to certain receptors in the brain and nervous system to reduce pain.

Do NOT use Morphine Extended-Release Capsules if:

you are allergic to any ingredient in Morphine Extended-Release Capsules or any other codeine- or morphine-related medicine (eg, codeine, oxycodone)
you have severe diarrhea, bowel problems caused by antibiotics or food poisoning, a blockage of your stomach or bowel, or certain other severe bowel problems (eg, paralytic ileus)
you have difficult or slowed breathing, high levels of carbon dioxide in the blood, or severe asthma, or you are having an asthma attack
you are taking or have taken a monamine oxidase inhibitor (MAOI) (eg, phenelzine) within the past 14 days
you are taking sodium oxybate (GHB)
you are in labor

Contact your doctor or health care provider right away if any of these apply to you.

Before using Morphine Extended-Release Capsules:

Some medical conditions may interact with Morphine Extended-Release Capsules. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a history of lung or breathing problems (eg, asthma, emphysema, bronchitis, chronic obstructive pulmonary disease [COPD]), sleep apnea (you stop breathing when you sleep), curvature of the spine (eg, kyphoscoliosis), heart problems (eg cor pulmonale), low blood pressure, dehydration, or low blood volume
if you have liver problems, kidney problems, adrenal gland problems (eg, Addison disease), an underactive thyroid, a blockage of your bladder, an enlarged prostate, or trouble urinating
if you have a history of a blockage of your bowel or other stomach or bowel problems (eg, inflammation), pancreas or gallbladder problems, or recent stomach or bowel surgery, or you are unable to swallow
if you have severe drowsiness, a recent head injury, growths in the brain (eg, tumors), increased pressure in the brain, or a history of seizures (eg, epilepsy)
if you drink regularly, have symptoms of alcohol withdrawal, or have a history of suicidal thoughts or attempts
if you have a personal or family history of mental or mood problems, alcohol abuse, or other substance abuse or dependence
if you are in poor health or will be having surgery

Some MEDICINES MAY INTERACT with Morphine Extended-Release Capsules. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antiemetics (eg, metoclopramide), phenothiazines (eg, chlorpromazine), sleeping medicines (eg, zolpidem), or tranquilizers (eg, olanzapine) because the risk of breathing problems, low blood pressure, severe drowsiness, or coma may be increased
Barbiturate anesthetics (eg, thiopental), cimetidine, MAOIs (eg, phenelzine), muscle relaxants (eg, carisoprodol), or sodium oxybate (GHB) because the risk of confusion, severe drowsiness, severe breathing problems, and coma may be increased
Mixed narcotic agonists/antagonists (eg, pentazocine), naltrexone, or rifampin because they may decrease Morphine Extended-Release Capsules’s effectiveness
Diuretics (eg, furosemide, hydrochlorothiazide) because their effectiveness may be decreased by Morphine Extended-Release Capsules

This may not be a complete list of all interactions that may occur. Ask your health care provider if Morphine Extended-Release Capsules may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Morphine Extended-Release Capsules:

Use Morphine Extended-Release Capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Morphine Extended-Release Capsules by mouth with or without food.
Swallow Morphine Extended-Release Capsules whole. Do not crush, chew, or dissolve Morphine Extended-Release Capsules before swallowing. If you cannot swallow the capsule whole, you may open it and sprinkle the contents over a spoonful of applesauce. Mix the medicine with the applesauce and swallow the mixture right away, followed by a glass of water. Do not crush or chew the medicine before swallowing. Do not store the mixture for future use.
Take Morphine Extended-Release Capsules on a regular schedule to get the most benefit from it. Do not take doses of Morphine Extended-Release Capsules closer than 12 hours apart.
Continue to take Morphine Extended-Release Capsules even if you feel well. Do not miss any doses.
Do not suddenly stop taking Morphine Extended-Release Capsules. You may have an increased risk of withdrawal symptoms (eg, anxiety, stomach cramps). If you need to stop Morphine Extended-Release Capsules or add a new medicine, your doctor will gradually lower your dose.
If you miss a dose of Morphine Extended-Release Capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Morphine Extended-Release Capsules.

Important safety information:

Morphine Extended-Release Capsules may cause dizziness, drowsiness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Morphine Extended-Release Capsules with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Morphine Extended-Release Capsules; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
Morphine Extended-Release Capsules may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
Do not change brands of Morphine Extended-Release Capsules without talking to your doctor. Products made by other companies may not work as well for you.
Constipation is a common side effect of Morphine Extended-Release Capsules. Talk to your doctor about using laxatives or stool softeners to prevent or treat constipation while you use Morphine Extended-Release Capsules.
Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. Misuse or abuse of Morphine Extended-Release Capsules may cause severe breathing problems, seizures, coma, and possibly death. Tell your doctor if you have breakthrough pain while you use Morphine Extended-Release Capsules.
Tell your doctor or dentist that you take Morphine Extended-Release Capsules before you receive any medical or dental care, emergency care, or surgery.
Use Morphine Extended-Release Capsules with caution in the ELDERLY; they may be more sensitive to its effects, especially dizziness and constipation.
Morphine Extended-Release Capsules should not be used in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed.
PREGNANCY and BREAST-FEEDING: Morphine Extended-Release Capsules may cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Morphine Extended-Release Capsules while you are pregnant. Morphine Extended-Release Capsules are found in breast milk. Do not breast-feed while taking Morphine Extended-Release Capsules.

When used for long periods of time or at high doses, Morphine Extended-Release Capsules may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Morphine Extended-Release Capsules stops working well. Do not take more than prescribed.

Some people who use Morphine Extended-Release Capsules for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction.

If you suddenly stop taking Morphine Extended-Release Capsules, you may have WITHDRAWAL symptoms. These may include restlessness, increased tearing, runny nose, yawning, sweating, chills, muscle pain, dilated pupils, irritability, anxiety, backache, joint pain, weakness, stomach cramps, trouble sleeping, nausea, loss of appetite, vomiting, diarrhea, fast breathing, and fast heartbeat.

Possible side effects of Morphine Extended-Release Capsules:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Anxiety; constipation; dizziness; drowsiness; lightheadedness; nausea; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; difficulty urinating; emotional or mood changes; fainting; fast, slow, or irregular heartbeat; hallucination; incoordination; seizures; severe or persistent drowsiness, dizziness, nausea, or vomiting; slow, shallow, or difficult breathing; slurred speech; swelling of the arms or legs; unusual tiredness or weakness; vision changes.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include cold and clammy skin; coma; incoordination; severe drowsiness; severe muscle weakness; slow heartbeat; slow, shallow, or difficult breathing; very large or very small pupils.

Proper storage of Morphine Extended-Release Capsules:

Store Morphine Extended-Release Capsules at 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, light, and moisture. Do not store in the bathroom. Keep Morphine Extended-Release Capsules out of the reach of children and away from pets.

General information:

If you have any questions about Morphine Extended-Release Capsules, please talk with your doctor, pharmacist, or other health care provider.
Morphine Extended-Release Capsules are to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Morphine Extended-Release Capsules. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: May 5, 2010

Database Edition 10.2.1.002

M,Med-facts

Comments (0)

Morphine Suppositories

30/06/10

Generic Name: Morphine (MORE-feen)
Brand Name: RMS

Morphine Suppositories are used for:

Preventing severe pain.

Morphine Suppositories are a narcotic pain reliever. It works by dulling the pain perception center in the brain. It may also affect other body systems (eg, respiratory and circulatory systems) at higher doses.

Do NOT use Morphine Suppositories if:

you are allergic to any ingredient in Morphine Suppositories
you have known or suspected paralysis of the intestines or antibiotic-associated colitis
you have diarrhea due to poisoning
you are taking cimetidine, sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline), or drink alcohol
you are taking or have taken a monoamine oxidase inhibitor (MAOI) (eg, phenelzine) within the past 14 days
you have slowed breathing, increased pressure in the head, a lesion in the head, or recent head injury
you are having an asthma attack, or have heart failure due to lung disease, arrhythmias, or seizures
you have had stomach tract surgery

Contact your doctor or health care provider right away if any of these apply to you.

Before using Morphine Suppositories:

Some medical conditions may interact with Morphine Suppositories. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a history of substance abuse or dependence, have asthma, chronic obstructive pulmonary disease (COPD), or other lung or breathing problems
if you have heart, liver, or thyroid diseases; curvature of the spine; or a history of suicidal thoughts or behaviors
if you have low blood volume, a stomach blockage, or inflammatory bowel disease

Some MEDICINES MAY INTERACT with Morphine Suppositories. Tell your health care provider if you are taking any other medicines, especially any of the following:

Fluoxetine, naltrexone, rifampin, or risperidone because they may decrease Morphine Suppositories’s effectiveness
Barbiturate anesthetics (eg, thiopental), cimetidine, ethanol, ketorolac, sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because side effects such as CNS toxicity (disorientation, respiratory depression, seizures) may occur
Barbiturate anesthetics (eg, thiopental) or sodium oxybate (GHB) because the risk of their side effects may be increased by Morphine Suppositories
Mexiletine or trovafloxacin because their effectiveness may be decreased by Morphine Suppositories

This may not be a complete list of all interactions that may occur. Ask your health care provider if Morphine Suppositories may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Morphine Suppositories:

Use Morphine Suppositories as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Wash your hands before and after using Morphine Suppositories. If the suppository is too soft to use, put it in the refrigerator for about 15 minutes. You may also run cold water over it. Remove the wrapper. Moisten the suppository with cool water. Lie down on your side. Insert the pointed end of the suppository into the rectum. Use your finger to push it in completely.
Take Morphine Suppositories on a regular schedule to get the most benefit from it. It is more effective in preventing pain than in treating pain after it occurs.
If you also take trovafloxacin, do not take it within 4 hours before or after taking Morphine Suppositories. Check with your doctor if you have questions.
If you miss a dose of Morphine Suppositories and you are using it regularly, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regularly dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Morphine Suppositories.

Important safety information:

Morphine Suppositories may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Morphine Suppositories with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Morphine Suppositories; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
Morphine Suppositories may cause constipation. Constipation may be avoided by using a stool softener or fiber laxative.
The risk of Morphine Suppositories becoming habit-forming may be greater if you take it in high doses or for a long time. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
Tell your doctor or dentist that you take Morphine Suppositories before you receive any medical or dental care, emergency care, or surgery.
Do not take Morphine Suppositories if you have had a severe allergic reaction to morphine or hydromorphone (such as MS Contin , Roxanol, Dilaudid). If you have a question about whether you are allergic to Morphine Suppositories or if a certain medicine contains morphine or hydromorphone, contact your doctor or pharmacist.
Lab tests may be performed while you use Morphine Suppositories. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Use Morphine Suppositories with caution in the ELDERLY; they may be more sensitive to its effects.
Morphine Suppositories should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Morphine Suppositories while you are pregnant. Morphine Suppositories are found in breast milk. Do not breast-feed while taking Morphine Suppositories.

When used for long periods of time or at high doses, Morphine Suppositories may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Morphine Suppositories stops working well. Do not take more than prescribed.

Some people who use Morphine Suppositories for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction. If you stop taking Morphine Suppositories suddenly, you may have WITHDRAWAL symptoms. These may include anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.

Possible side effects of Morphine Suppositories:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Agitation; blurred vision; constipation; dizziness; drowsiness; exaggerated sense of well-being; feeling disoriented; headache; lightheadedness; nausea; restless mood; sleeplessness; sweating; vision problems; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue); bleeding hives; pounding in the chest; seizure; shock; shortness of breath; slow heartbeat; sudden chest pain; vomiting.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include cold and clammy skin; convulsions; deep sleep; lightheadedness; loss of consciousness; slowed breathing; slowed heart rate.

Proper storage of Morphine Suppositories:

Store Morphine Suppositories between 68 and 77 degrees F (20 and 25 degrees C). Store in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Morphine Suppositories out of the reach of children and away from pets.

General information:

If you have any questions about Morphine Suppositories, please talk with your doctor, pharmacist, or other health care provider.
Morphine Suppositories are to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Morphine Suppositories. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: May 5, 2010

Database Edition 10.2.1.002

M,Med-facts

Comments (0)

morphine (Oral route)

30/06/10

MOR-feen

Injection routeSolution

Duramorph(TM)
- Because of the risk of severe adverse effects when the epidural or intrathecal route of administration is employed, patients must be observed in a fully equipped and staffed environment for at least 24 hours after the initial dose.
- Naloxone injection and resuscitative equipment should be immediately available for administration in case of life-threatening or intolerable side effects and whenever Duramorph(TM) therapy is being initiated.
- Note: Intrathecal dosage is usually 1/10 that of epidural dosage.
- Duramorph(TM) is supplied in sealed ampuls. Accidental dermal exposure should be treated by the removal of any contaminated clothing and rising the affected area with water.
- Each ampul of Duramorph(TM) contains a potent narcotic which has been associated with abuse and dependence among health care providers. Due to the limited indication for this product, the risk of overdosage and the risk of its diversion and abuse, it is recommended that special measures be taken to control this product within the hospital or clinic.
- Duramorph(TM) should be subject to rigid accounting, rigorous control of wastage and restricted access.
- Parenteral drug products should be inspected for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use if color is darker than pale yellow, if it is discolored in any other way or it contains a precipitate .

Duramorph(TM): There is a risk of severe adverse effects when the epidural or intrathecal route of administration is employed. Monitor patients closely and have naloxone injection and resuscitative equipment immediately available. The intrathecal dosage is usually 1/10 that of epidural dosage. Duramorph(TM) contains a potent narcotic which has been associated with abuse and dependence among health care providers .

Oral routeCapsule, Extended Release

Kadian(R)
- Kadian(R) contains morphine sulfate, an opioid agonist and a Schedule II controlled substance, with an abuse liability similar to other opioid analgesics. Kadian(R) can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing Kadian(R) in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse or diversion. Kadian(R) capsules are an extended-release oral formulation of morphine sulfate indicated for the management of moderate to severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. Kadian(R) capsules are NOT for use as a prn analgesic. Kadian(R) 100 mg and 200 mg capsules are for use in opioid-tolerant patients only. Ingestion of these capsules or of the pellets within the capsules may cause fatal respiratory depression when administered to patients not already tolerant to high doses of opioids. Kadian(R) capsules are to be swallowed whole or the contents of the capsules sprinkled on applesauce. The pellets in the capsules are not to be chewed, crushed, or dissolved due to the risk of rapid release and absorption of a potentially fatal dose of morphine .

Kadian(R): contains morphine sulfate, an opioid agonist and Schedule II controlled substance, with an abuse liability similar to other opioid analgesics. Kadian(R) is indicated for the management of moderate-to-severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. The 100-mg and 200-mg capsules are for use in opioid-tolerant patients only. Kadian(R) capsules should be swallowed whole or the contents sprinkled on applesauce. Do not crush, chew, or dissolve capsule pellets due to the risk of rapid release and absorption of a potentially fatal dose of morphine .

Oral routeCapsule, Extended Release, 24 HR

Avinza(R)
- Avinza(R) capsules are a modified-release formulation of morphine sulfate indicated for once daily administration for the relief of moderate to severe pain requiring continuous, around-the-clock opioid therapy for an extended period of time. AVINZA(R) capsules are to be swallowed whole or the contents of the capsules sprinkled on applesauce. The capsule beads are not to be chewed, crushed, or dissolved due to the risk of rapid release and absorption of a potentially fatal dose of morphine. Patients must not consume alcoholic beverages while on Avinza(R) therapy. Additionally, patients must not use prescription or non-prescription medications containing alcohol while on Avinza(R) therapy. Consumption of alcohol while taking Avinza(R) may result in the rapid release and absorption of a potentially fatal dose of morphine .

Avinza(R): capsules are a modified-release formulation of morphine sulfate indicated for once daily administration for the relief of moderate to severe pain requiring continuous, around-the-clock opioid therapy for an extended period of time. Avinza(R) capsules should be swallowed whole or the contents sprinkled on applesauce. Do not crush, chew, or dissolve capsule beads due to the risk of rapid release and absorption of a potentially fatal dose of morphine. Avoid alcohol and alcohol-containing medications as consumption of alcohol may result in the rapid release and absorption of a potentially fatal dose of morphine .

Oral routeSolution

Risk of Medication Errors
- Morphine oral solution is available in 10 mg per 5 mL, 20 mg per 5 mL and 100 mg per 5 mL (20 mg/mL) concentrations.
- The 100 mg per 5 mL (20 mg/mL) concentration is indicated for use in opioid-tolerant patients only.
- Take care when prescribing and administering morphine oral solution to avoid dosing errors due to confusion between different concentrations and between mg and mL, which could result in accidental overdose and death. Take care to ensure the proper dose is communicated and dispensed.
- Keep morphine oral solution out of the reach of children. In case of accidental ingestion, seek emergency medical help immediately .

Morphine oral solution is available in 10 mg/5 mL, 20 mg/5 mL and 100 mg/5 mL (20 mg/mL) concentrations. The 100 mg/5 mL (20 mg/mL) concentration is indicated for use in opioid-tolerant patients only. Take care to avoid dosing errors due to confusion between different concentrations and between mg and mL, which could result in accidental overdose and death. Keep morphine oral solution out of the reach of children .

Oral routeTablet, Extended Release

MS Contin(R)
- MS Contin(R) contains morphine sulfate, an opioid agonist and a Schedule II controlled substance, with an abuse liability similar to other opioid analgesics.
- Morphine can be abused in a manner similar to other opioid agonists, legal or illicit. This should be considered when prescribing or dispensing MS Contin(R) in situations where the physician or pharmacist is concerned about an increased risk of misuse, abuse, or diversion.
- MS Contin(R) tablets are a controlled-release oral formulation of morphine sulfate indicated for the management of moderate-to-severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time.
- MS Contin(R) tablets are NOT intended for use as a prn analgesic.
- MS Contin(R) 100 and 200 mg tablets are for use in opioid-tolerant patients only. These tablet strengths may cause fatal respiratory depression when administered to patients not previously exposed to opioids.
- MS Contin(R) tablets are to be swallowed whole and are not to be broken, chewed, dissolved, or crushed. Taking broken, chewed, dissolved, or crushed MS Contin(R) tablets leads to rapid release and absorption of a potentially fatal dose of morphine .
Oramorph(R) SR
- Oramorph(R) SR is a sustained-release dosage form. Patients should be instructed to swallow the tablet whole. The tablet should not be broken in half, nor should it be crushed or chewed. The sustained release of morphine from Oramorph(R) SR should be taken into consideration in the event of adverse reactions or overdosage .

MS Contin(R): 100 mg and 200 mg tablets are for use in opioid-tolerant patients only. MS Contin(R) tablets are a controlled-release formulation, should be swallowed whole and are not to be broken, chewed, dissolved, or crushed due to the risk of rapid release and absorption of a potentially fatal dose of morphine . Oramorph(R) SR: is a sustained-release dosage form. Swallow the tablet whole; the tablet should not be broken in half, nor should it be crushed or chewed .

Commonly used brand name(s):

In the U.S.

Avinza
Kadian
Kadian ER
MS Contin
MSIR
Oramorph SR
Roxanol
Roxanol-T

Available Dosage Forms:

Capsule, Extended Release
Capsule, Extended Release, 24 HR
Tablet, Extended Release
Capsule
Tablet
Powder for Suspension, Extended Release
Solution
Capsule, Delayed Release
Syrup

Therapeutic Class: Analgesic

Chemical Class: Opioid

Uses For morphine

Morphine is used to relieve moderate to severe pain. It belongs to the group of medicines called narcotic analgesics (pain medicines). Morphine acts on the central nervous system (CNS) to relieve pain.

When morphine is used for a long time, it may become habit-forming, causing mental or physical dependence. However, people who have continuing pain should not let the fear of dependence keep them from using narcotics to relieve their pain. Mental dependence (addiction) is not likely to occur when narcotics are used for this purpose. Physical dependence may lead to withdrawal side effects if treatment is stopped suddenly. However, severe withdrawal side effects can usually be prevented by gradually reducing the dose over a period of time before treatment is stopped completely.

morphine is available only with your doctor’s prescription.

Before Using morphine

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 liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving morphine.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

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.

Brofaromine
Clorgyline
Furazolidone
Iproniazid
Isocarboxazid
Lazabemide
Linezolid
Moclobemide
Naltrexone
Nialamide
Pargyline
Phenelzine
Procarbazine
Rasagiline
Selegiline
Toloxatone
Tranylcypromine

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.

Adinazolam
Alfentanil
Alprazolam
Amobarbital
Anileridine
Aprobarbital
Bromazepam
Brotizolam
Buprenorphine
Butabarbital
Butalbital
Butorphanol
Carisoprodol
Chloral Hydrate
Chlordiazepoxide
Chlorpromazine
Chlorzoxazone
Cimetidine
Clobazam
Clonazepam
Clorazepate
Codeine
Dantrolene
Dezocine
Diazepam
Estazolam
Ethchlorvynol
Fentanyl
Flunitrazepam
Fluphenazine
Flurazepam
Halazepam
Hydrocodone
Hydromorphone
Ketazolam
Levorphanol
Lorazepam
Lormetazepam
Medazepam
Meperidine
Mephenesin
Mephobarbital
Meprobamate
Metaxalone
Methocarbamol
Methohexital
Midazolam
Morphine
Morphine Sulfate Liposome
Nalbuphine
Nitrazepam
Nordazepam
Opium
Oxazepam
Oxycodone
Oxymorphone
Pentazocine
Pentobarbital
Perphenazine
Phenobarbital
Prazepam
Prochlorperazine
Promazine
Promethazine
Propoxyphene
Quazepam
Remifentanil
Secobarbital
Sodium Oxybate
Sufentanil
Tapentadol
Temazepam
Thiethylperazine
Thiopental
Thioridazine
Triazolam
Trifluoperazine

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.

Cyclosporine
Esmolol
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

Proper Use of morphine

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).

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 break, crush, 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.

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:
  - Patients switching from regular morphine forms:
    - Adults—The capsule is given once a day. The initial dose in milligrams (mg) per day is the same as the total amount of regular morphine that is taken per day. Your doctor may adjust your dose if needed. However, the dose is usually not more than 1600 mg per day.
    - Children—Use and dose must be determined by your doctor.
  - Patients who are not taking narcotic medicines:
    - Adults—At first, 30 milligrams (mg) once a day. Your doctor may adjust your dose if needed. However, the dose is usually not more than 1600 mg per day.
    - Children—Use and dose must be determined by your doctor.
For oral dosage form (extended-release tablets):
- For moderate to severe pain:
  - Patients switching from regular morphine forms:
    - Adults—The tablet is given every 8 hours or every 12 hours. The total amount of milligrams (mg) per day is the same as the total amount of regular morphine that is taken per day. The total amount per day will be divided and given as 2 or 3 doses during the day. Your doctor may adjust your dose if needed.
    - 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, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. 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 who are not used to strong narcotic pain medicines, children, or pets. Make sure you store the medicine in a safe and secure place to prevent others from getting it.

Flush the unused capsules, liquid, and tablets down the toilet.

Precautions While Using morphine

It is very important that your doctor check your progress while you are taking morphine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

morphine will add to the effects of alcohol and other CNS depressants (medicines that can make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds; sedatives, tranquilizers, or sleeping medicine; other prescription pain medicine or narcotics; medicine for seizures or barbiturates; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of these medicines while you are using morphine.

morphine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose.

Dizziness, lightheadedness, or fainting may occur when you get up suddenly from a lying or sitting position. Getting up slowly may help lessen this problem. Also, lying down for a while may relieve the dizziness or lightheadedness.

morphine may make you dizzy, drowsy, confused, or disoriented. Make sure you know how you react to morphine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or not alert.

Using narcotics for a long time can cause severe constipation. To prevent this, your doctor may direct you to take laxatives, drink a lot of fluids, or increase the amount of fiber in your diet. Be sure to follow the directions carefully, because continuing constipation can lead to more serious problems.

morphine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, or mouth while you are using morphine.

If you have been using morphine regularly for several weeks or longer, do not change your dose or suddenly stop using it without checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent worsening of your condition and reduce the possibility of withdrawal symptoms, such as abdominal or stomach cramps, anxiety, fever, nausea, runny nose, sweating, tremors, or trouble with sleeping.

Using morphine while you are pregnant may cause serious unwanted effects in your newborn baby. Tell your doctor right away if you think you are pregnant or if you plan to become pregnant while using morphine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

morphine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

Abdominal or stomach pain
blurred vision
bulging soft spot on the head of an infant
burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
change in the ability to see colors, especially blue or yellow
chest pain or discomfort
chills
confusion
cough
decreased urination
difficulty with breathing
difficulty with swallowing
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
fast, pounding, or irregular heartbeat or pulse
headache
hives
increased sweating
insomnia
itching
loss of appetite
nausea
nervousness
noisy breathing
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
severe constipation
severe vomiting
shakiness in the legs, arms, hands, or feet
shortness of breath
skin rash
slow or irregular heartbeat
sweating
swelling
tightness in the chest
trembling or shaking of the hands or feet
trouble with breathing
trouble with urinating
unusual tiredness or weakness
vomiting
wheezing

Incidence not known

Black, tarry stools
bleeding gums
blood in the urine or stools
bluish lips or skin
change in consciousness
chest pain or discomfort
cold, clammy skin
convulsions
decrease in the amount of urine
decrease in the frequency of urination
difficulty in passing urine (dribbling)
extremely shallow or slow breathing
fast, weak pulse
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
irregular, fast or slow, or shallow breathing
lightheadedness
loss of consciousness
low blood pressure or pulse
nervousness
painful urination
pale or blue lips, fingernails, or skin
pale skin
pinpoint red spots on the skin
pounding in the ears
shakiness and unsteady walk
troubled breathing with exertion
unconsciousness
unsteadiness, trembling, or other problems with muscle control or coordination
unusual bleeding or bruising
very slow breathing
very slow heartbeat

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Bloody urine
constricted, pinpoint, or small pupils (black part of the eye)
dark-colored urine
decreased awareness or responsiveness
extreme drowsiness
fever
increased blood pressure
increased thirst
lower back or side pain
muscle cramps or spasms
muscle pain or stiffness
no muscle tone or movement
severe sleepiness
swelling of the face, fingers, or lower legs
weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Cramps
diarrhea
difficulty having a bowel movement (stool)
drowsiness
false or unusual sense of well-being
relaxed and calm feeling
sleepiness or unusual drowsiness
weight loss

Less common

Absent, missed, or irregular menstrual periods
acid or sour stomach
agitation
bad, unusual, or unpleasant (after) taste
belching
blurred or loss of vision
change in taste
decreased interest in sexual intercourse
depression
disturbed color perception
double vision
dry mouth
face is warm or hot to touch
fear
floating feeling
halos around lights
heartburn
inability to have or keep an erection
indigestion
loss in sexual ability, desire, drive, or performance
muscle stiffness or tightness
nervousness
night blindness
overbright appearance of lights
problems with muscle control
redness of the skin
seeing double
skin rash
sleeplessness
stomach discomfort, upset, or pain
stopping of menstrual bleeding
trouble sleeping
tunnel vision
unable to sleep
uncontrolled eye movements
upper abdominal or stomach pain
weakness

Incidence not known

Abnormal dreams
belching
burning while urinating
change in vision
change in walking and balance
change or problem with discharge of semen
clumsiness or unsteadiness
confusion as to time, place, or person
delusions
dementia
dry skin
eye pain
feeling of constant movement of self or surroundings
general feeling of discomfort or illness
hiccup
holding false beliefs that cannot be changed by fact
impaired vision
indigestion
loss of memory
problems with memory
seeing, hearing, or feeling things that are not there
sensation of spinning
thirst
unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
unusual excitement, nervousness, or restlessness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Thomson Reuters Micromedex products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Reuters Healthcare products is at your sole risk. These products are provided “AS IS” and “as available” for use, without warranties of any kind, either express or implied. Thomson Reuters Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON REUTERS HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Reuters Healthcare does not assume any responsibility or risk for your use of the Thomson Reuters Healthcare products.

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morphine (Epidural route)

30/06/10

MOR-feen SUL-fate LYE-poh-some

Commonly used brand name(s):

In the U.S.

DepoDur

Available Dosage Forms:

Suspension, Extended Release

Therapeutic Class: Analgesic

Chemical Class: Opioid

Uses For morphine

Morphine epidural injection is used to relieve pain following a major surgery. It is given right before a surgery or during a cesarean section delivery right after the baby’s umbilical cord is clamped.

Morphine belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain.

morphine is available only with your doctor’s prescription and will be given by or under the immediate supervision of your doctor.

Before Using morphine

Allergies

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of morphine epidural injection in the pediatric population. Use of morphine epidural injection is not recommended in children.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of morphine epidural injection in the elderly. However, elderly patients are more likely to have age-related heart, stomach, or lung problems, which may require caution and an adjustment in the dose for patients receiving morphine epidural injection.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	C	Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

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

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.

Brofaromine
Clorgyline
Furazolidone
Iproniazid
Isocarboxazid
Lazabemide
Linezolid
Moclobemide
Naltrexone
Nialamide
Pargyline
Phenelzine
Procarbazine
Rasagiline
Selegiline
Toloxatone
Tranylcypromine

Adinazolam
Alfentanil
Alprazolam
Amobarbital
Anileridine
Aprobarbital
Bromazepam
Brotizolam
Buprenorphine
Butabarbital
Butalbital
Butorphanol
Carisoprodol
Chloral Hydrate
Chlordiazepoxide
Chlorpromazine
Chlorzoxazone
Cimetidine
Clobazam
Clonazepam
Clorazepate
Codeine
Dantrolene
Dezocine
Diazepam
Droperidol
Estazolam
Ethchlorvynol
Fentanyl
Flunitrazepam
Fluphenazine
Flurazepam
Halazepam
Hydrocodone
Hydromorphone
Ketazolam
Levorphanol
Lorazepam
Lormetazepam
Medazepam
Meperidine
Mephenesin
Mephobarbital
Meprobamate
Metaxalone
Methocarbamol
Methohexital
Midazolam
Morphine
Morphine Sulfate Liposome
Nalbuphine
Nitrazepam
Nordazepam
Opium
Oxazepam
Oxycodone
Oxymorphone
Pentazocine
Pentobarbital
Perphenazine
Phenobarbital
Prazepam
Prochlorperazine
Promazine
Promethazine
Propoxyphene
Quazepam
Remifentanil
Secobarbital
Sodium Oxybate
Sufentanil
Tapentadol
Temazepam
Thiethylperazine
Thiopental
Thioridazine
Triazolam
Trifluoperazine

Chloroprocaine
Cyclosporine
Epinephrine
Esmolol
Lidocaine
Rifampin
Somatostatin
Yohimbine

Interactions with Food/Tobacco/Alcohol

Ethanol

Proper Use of morphine

A nurse or other trained health professional will give you morphine in a hospital. morphine is given through a needle or catheter in your back (epidural).

Precautions While Using morphine

It is important that your doctor check your progress after you receive morphine. This is to make sure that the medicine is working properly, and to allow your doctor to check for any unwanted effects.

morphine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Blurred vision
confusion
decrease in the frequency of urination
decrease in urine volume
difficulty in passing urine (dribbling)
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
fast, pounding, or irregular heartbeat or pulse
painful urination
pale skin
shortness of breath
sweating
unusual tiredness or weakness

Less common

Abdominal or stomach cramps or pain
bloating
constipation
convulsions
diarrhea
difficult or labored breathing
dry mouth
increased thirst
irregular, fast, slow, or shallow breathing
loss of appetite
mood changes
muscle pain or cramps
pale or blue lips, fingernails, or skin
restlessness
shakiness
sleepiness
slow to respond
slurred speech
tightness in the chest
unconsciousness
vomiting
wheezing

Incidence not known

Bluish lips or skin
disorientation
hallucinations
lethargy
low blood pressure or pulse
severe drowsiness
slowing of the heartbeat
unresponsiveness
very slow breathing

More common

Bloated or full feeling
excess air or gas in the stomach or intestines
fever
headache
nausea
passing gas
skin itching
sleeplessness
trouble sleeping
troubled breathing with exertion
unable to sleep
unusual bleeding or bruising

Less common

Back pain
burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
chest pain or discomfort
fear or nervousness
feeling unusually cold
lower abdominal or stomach pain or pressure
pounding in the ears
pressure in the stomach
shivering
slow or irregular heartbeat
swelling of the abdominal or stomach area

Incidence not known

Not alert
trouble with coordination

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Morphine Solution

30/06/10

Generic Name: Morphine (MORE-feen)
Brand Name: Examples include Astramorph PF and Duramorph

Morphine Solution is used for:

Treating pain. It may also be used for other conditions as determined by your doctor.

Morphine Solution is a narcotic pain reliever. It works by dulling the pain perception center in the brain. It may also affect other body systems (eg, breathing and circulatory systems) at higher doses.

Do NOT use Morphine Solution if:

you are allergic to any ingredient in Morphine Solution
you are taking cimetidine, a phenothiazine (eg, chlorpromazine), sodium oxybate (GHB), or a tricyclic antidepressant (eg, amitriptyline), or you drink alcohol
you have known or suspected paralysis of the intestines or antibiotic-associated colitis
you have diarrhea due to poisoning
you have an upper airway (breathing) obstruction or low blood volume, or you are having an asthma attack
you will be having general anesthesia

Contact your doctor or health care provider right away if any of these apply to you.

Before using Morphine Solution:

Some medical conditions may interact with Morphine Solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have asthma, chronic obstructive pulmonary disease (COPD), or other lung or breathing problems, or you have a history of drug abuse or dependence
if you have increased pressure in the head, a recent head injury, or lesions in the head
if you have heart, liver, or thyroid disease; curvature of the spine; seizures; or a history of suicidal thoughts or behaviors
if you have a stomach blockage or inflammatory bowel disease, or you recently had stomach tract surgery

Some MEDICINES MAY INTERACT with Morphine Solution. Tell your health care provider if you are taking any other medicines, especially any of the following:

Fluoxetine, naltrexone, rifampin, or risperidone because they may decrease the effectiveness of Morphine Solution
Barbiturate anesthetics (eg, thiopental), cimetidine, ethanol, ketorolac, phenothiazines (eg, chlorpromazine), sodium oxybate (GHB ), or tricyclic antidepressants (eg, amitriptyline) because side effects (eg, disorientation, respiratory depression, seizures) may occur
Barbiturate anesthetics (eg, thiopental) or sodium oxybate (GHB) because the risk of their side effects may be increased by Morphine Solution
Mexiletine or trovafloxacin because their effectiveness may be decreased by Morphine Solution

This may not be a complete list of all interactions that may occur. Ask your health care provider if Morphine Solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Morphine Solution:

Use Morphine Solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Morphine Solution is usually given as an injection at your doctor’s office, hospital, or clinic. If you will be using Morphine Solution at home, a health care provider will teach you how to use it. Be sure you understand how to use Morphine Solution. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
Do not use Morphine Solution if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
If you also take trovafloxacin, do not take it within 4 hours before or after taking Morphine Solution. Check with your doctor if you have questions.
Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
If you miss a dose of Morphine Solution and you are using it regularly, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Morphine Solution.

Important safety information:

Morphine Solution may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Morphine Solution with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Morphine Solution; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
The risk of Morphine Solution becoming habit-forming may be greater if you take it in high doses or for a long time. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
Tell your doctor or dentist that you take Morphine Solution before you receive any medical or dental care, emergency care, or surgery.
Do not take Morphine Solution if you have had a severe allergic reaction to morphine or hydromorphone (eg, MS Contin, Roxanol, Dilaudid). If you have a question about whether you are allergic to Morphine Solution or if a certain medicine contains morphine or hydromorphone, contact your doctor or pharmacist.
Some of these products contain sulfites. Sulfites may cause an allergic reaction in some patients (eg, asthma patients). If you have ever had an allergic reaction to sulfites, ask your pharmacist if your product has sulfites in it.
Lab tests, including liver function, kidney function, lung function, and complete blood cell counts, may be performed while you use Morphine Solution. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Use Morphine Solution with caution in the ELDERLY; they may be more sensitive to its effects.
Morphine Solution should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Morphine Solution while you are pregnant. Morphine Solution is found in breast milk. Do not breast-feed while taking Morphine Solution.

When used for long periods of time or at high doses, Morphine Solution may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Morphine Solution stops working well. Do not take more than prescribed.

Some people who use Morphine Solution for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction. If you stop taking Morphine Solution suddenly, you may have WITHDRAWAL symptoms. These may include anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing, or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.

Possible side effects of Morphine Solution:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Agitation; anxiety; changes in vision; confusion; constipation; decreased sex drive; dizziness; drowsiness; dry mouth; exaggerated sense of well-being; fear; frequent urination; headache; incoordination; lack of energy; lightheadedness; loss of appetite; mental clouding; mood swings; nausea; pinpoint pupils; restless mood; sleeplessness; sweating; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); decreased sexual ability; delirium; difficulty urinating; disorientation; fainting; fast or slow heartbeat; flushing of the face; hallucinations; itching; menstrual changes; mental or mood changes; pounding in the chest; seizures; slowed breathing; tremor; vomiting.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include cold and clammy skin; convulsions; deep sleep; dizziness; drowsiness; lightheadedness; loss of consciousness; slowed breathing; slowed heartbeat.

Proper storage of Morphine Solution:

Store Morphine Solution between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep out of reach of children and away from pets.

General information:

If you have any questions about Morphine Solution, please talk with your doctor, pharmacist, or other health care provider.
Morphine Solution is to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Morphine Solution. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: May 5, 2010

Database Edition 10.2.1.002

M,Med-facts

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Morphine Sustained-Release Tablets

30/06/10

Generic Name: Morphine (MOR-feen)
Brand Name: Examples include MS Contin and Oramorph SR

Morphine Sustained-Release Tablets are used for:

Managing moderate to severe pain for more than a few days.

Morphine Sustained-Release Tablets are a narcotic pain reliever. It works by dulling the pain perception center in the brain. It may also affect other body systems (eg, breathing and circulatory systems) at higher doses.

Do NOT use Morphine Sustained-Release Tablets if:

you are allergic to any ingredient in Morphine Sustained-Release Tablets
you have known or suspected paralysis of the intestines or antibiotic-associated colitis
you have diarrhea due to poisoning, slowed breathing, severe asthma, or are having an asthma attack

Contact your doctor or health care provider right away if any of these apply to you.

Before using Morphine Sustained-Release Tablets:

Some medical conditions may interact with Morphine Sustained-Release Tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have a history of drug abuse or dependence, have asthma, chronic obstructive pulmonary disease (COPD), or other lung or breathing problems
if you have increased pressure in the head, recent head injury, or lesions in the head
if you have difficulty urinating; heart, liver, or thyroid disease; hypercapnia (abnormally increased carbon dioxide tension in your arteries); curvature of the spine; seizures; or a history of suicidal thoughts or behaviors
if you have low blood volume, a stomach blockage, inflammatory bowel disease, have had stomach tract surgery, or are in shock

Some MEDICINES MAY INTERACT with Morphine Sustained-Release Tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

Fluoxetine, naltrexone, narcotic agonists/antagonists (eg, pentazocine), rifampin, or risperidone because they may decrease Morphine Sustained-Release Tablets’s effectiveness
Barbiturate anesthetics (eg, thiopental), cimetidine, ethanol, ketorolac, sodium oxybate (GHB), or tricyclic antidepressants (eg, amitriptyline) because side effects such as CNS toxicity (disorientation, respiratory depression, seizures) may occur
Barbiturate anesthetics (eg, thiopental) or sodium oxybate (GHB) because the risk of their side effects may be increased by Morphine Sustained-Release Tablets
Mexiletine or trovafloxacin because their effectiveness may be decreased by Morphine Sustained-Release Tablets

This may not be a complete list of all interactions that may occur. Ask your health care provider if Morphine Sustained-Release Tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Morphine Sustained-Release Tablets:

Use Morphine Sustained-Release Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Morphine Sustained-Release Tablets by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
Swallow Morphine Sustained-Release Tablets whole. Do not break, crush, or chew before swallowing.
Take Morphine Sustained-Release Tablets on a regular schedule to get the most benefit from it. It is more effective in preventing pain than in treating pain after it occurs.
If you also take trovafloxacin, do not take it within 4 hours before or after taking Morphine Sustained-Release Tablets. Check with your doctor if you have questions.
If Morphine Sustained-Release Tablets are no longer needed, dispose of it as soon as possible. Ask your doctor or pharmacist how to dispose of Morphine Sustained-Release Tablets properly.
If you miss a dose of Morphine Sustained-Release Tablets, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Morphine Sustained-Release Tablets.

Important safety information:

Morphine Sustained-Release Tablets may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Morphine Sustained-Release Tablets with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Morphine Sustained-Release Tablets; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness.
Morphine Sustained-Release Tablets may cause constipation. Constipation may be avoided by using a stool softener or fiber laxative.
The risk of Morphine Sustained-Release Tablets becoming habit-forming may be greater if you take it in high doses or for a long time. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.
Tell your doctor or dentist that you take Morphine Sustained-Release Tablets before you receive any medical or dental care, emergency care, or surgery.
Do not take Morphine Sustained-Release Tablets if you have had a severe allergic reaction to morphine or hydromorphone (such as MS Contin, Roxanol, Dilaudid). If you have a question about whether you are allergic to Morphine Sustained-Release Tablets or if a certain medicine contains morphine or hydromorphone, contact your doctor or pharmacist.
Lab tests may be performed while you use Morphine Sustained-Release Tablets. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Use Morphine Sustained-Release Tablets with caution in the ELDERLY; they may be more sensitive to its effects.
Morphine Sustained-Release Tablets should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Morphine Sustained-Release Tablets while you are pregnant. Morphine Sustained-Release Tablets are found in breast milk. Do not breast-feed while taking Morphine Sustained-Release Tablets.

When used for long periods of time or at high doses, Morphine Sustained-Release Tablets may not work as well and may require higher doses to obtain the same effect as when originally taken. This is known as TOLERANCE. Talk with your doctor if Morphine Sustained-Release Tablets stops working well. Do not take more than prescribed.

Some people who use Morphine Sustained-Release Tablets for a long time may develop a need to continue taking it. People who take high doses are also at risk. This is known as DEPENDENCE or addiction.

If you stop taking Morphine Sustained-Release Tablets suddenly, you may have WITHDRAWAL symptoms. These may include anxiety; diarrhea; fever, runny nose, or sneezing; goose bumps and abnormal skin sensations; nausea; vomiting; pain; rigid muscles; rapid heartbeat; seeing, hearing or feeling things that are not there; shivering or tremors; sweating; and trouble sleeping.

Possible side effects of Morphine Sustained-Release Tablets:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; dizziness; drowsiness; exaggerated sense of well-being; headache; lightheadedness; nausea; restless mood; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); excessive drowsiness; fast or slow heartbeat; hallucinations; pounding in the chest; seizure; shock; shortness of breath; sudden chest pain; sweating; swelling of the face or throat.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include cold and clammy skin; convulsions; deep sleep; dizziness; drowsiness; lightheadedness; loss of consciousness; low body temperature; slowed breathing; slowed heartbeat.

Proper storage of Morphine Sustained-Release Tablets:

Store Morphine Sustained-Release Tablets between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, light, and moisture. Do not store in the bathroom. Keep Morphine Sustained-Release Tablets out of the reach of children and away from pets.

General information:

If you have any questions about Morphine Sustained-Release Tablets, please talk with your doctor, pharmacist, or other health care provider.
Morphine Sustained-Release Tablets are to be used only by the patient for whom it is prescribed. Do not share it with other people.
If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Morphine Sustained-Release Tablets. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: May 5, 2010

Database Edition 10.2.1.002

M,Med-facts

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moricizine

30/06/10

Generic Name: moricizine (more IH sih zeen)
Brand Names: Ethmozine

What is moricizine?

Moricizine affects the way that your heart beats.

Moricizine is used to treat seriously irregular heartbeat patterns.

Moricizine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about moricizine?

Call your doctor immediately if you experience chest pain, chest discomfort, worsening irregular heartbeats, or a fever.

Do not skip doses or change your dosing schedule without first talking to your doctor. Changing your schedule could make your condition much worse. It is important to take this medication exactly as directed by your doctor. Use caution when driving, operating machinery, or performing other hazardous activities. Moricizine may cause dizziness, drowsiness, or blurred vision. If you experience dizziness, drowsiness, or blurred vision, avoid these activities.

What should I discuss with my healthcare provider before taking moricizine?

Before taking moricizine, tell your doctor if you have

any other type of heart disease or heart problems,
liver disease, or
kidney disease.

You may not be able to take moricizine, or you may require a lower dose or special monitoring during treatment if you have any of the conditions listed above.

Moricizine is in the FDA pregnancy category B. This means that it is unlikely to harm an unborn baby. Do not take moricizine without first talking to your doctor if you are pregnant. Moricizine passes into breast milk. It is not known whether moricizine will affect a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

How should I take moricizine?

Take moricizine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water. Do not skip doses or change your dosing schedule without first talking to your doctor. Changing your schedule could make your condition much worse. It is important to take this medication exactly as directed by your doctor. Store moricizine at room temperature away from moisture and heat.

See also: Moricizine dosage in more detail

What happens if I miss a dose?

Try not to miss any doses of this medication. Missing doses could be very dangerous.

If you do miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication. A double dose could be dangerous.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a moricizine overdose include vomiting, tiredness, dizziness, an irregular heartbeat, severe chest pain, a heart attack, difficulty breathing, and coma.

What should I avoid while taking moricizine?

Use caution when driving, operating machinery, or performing other hazardous activities. Moricizine may cause dizziness, drowsiness, or blurred vision. If you experience dizziness, drowsiness, or blurred vision, avoid these activities.

Moricizine side effects

If you experience any of the following serious side effects, stop taking moricizine and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);
a new or a worsening irregular heartbeat pattern;
fever; or
chest pain or chest discomfort.

Other, less serious side effects may be more likely to occur. Continue to take moricizine and talk to your doctor if you experience

dizziness or tiredness;
anxiety;
upset stomach, vomiting, or diarrhea;
dry mouth;
headache; or
blurred vision.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

Moricizine Dosing Information

Usual Adult Dose for Ventricular Tachycardia:

Initial dose: 200 mg orally every 8 hours.
Maintenance dose: 200-300 mg orally every 8 hours.

What other drugs will affect moricizine?

Before taking moricizine, tell your doctor if you are taking any of the following drugs:

cimetidine (Tagamet, Tagamet HB);
cisapride (Propulsid);
diltiazem (Cardizem, Dilacor, Diltia XT, Tiazac);
propranolol (Inderal);
theophylline (Theo-Dur, Slo-Bid, Elixophyllin, Slo-Phyllin, Aerolate, Theolair, others);
warfarin (Coumadin); or
dofetilide (Tikosyn), procainamide (Procan SR, Procanbid, Pronestyl, Pronestyl-SR), sotalol (Betapace, Betapace AF), or another medicine used to treat irregular heartbeats.

You may not be able to take moricizine or you may require a dosage adjustment or special monitoring if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with moricizine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Where can I get more information?

Your pharmacist has more information about moricizine written for health professionals that you may read.

What does my medication look like?

Moricizine is available with a prescription under the brand name Ethmozine. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Ethmozine 200 mg–light-green, oval, film-coated tablets
Ethmozine 250 mg–light-orange, oval, film-coated tablets
Ethmozine 300 mg–light-blue, oval, film-coated tablets

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Concise,M

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moricizine (Oral route)

30/06/10

mor-I-si-zeen

Oral routeTablet

Moricizine hydrochloride was one of the three antiarrhythmic drugs included in the National Heart Lung and Blood Institute’s (NHLBI) Cardiac Arrhythmia Suppression Trial (CAST I), a long-term, multi-center, randomized, double-blind study in patients with asymptomatic non-life-threatening ventricular arrhythmias who had had a myocardial infarction more than six days, but less than two years previously. An excessive mortality or non-fatal cardiac arrest rate was seen in patients treated with both of the Class IC agents included in the trial, which led to discontinuation of those two arms of the trial. The average duration of treatment with these agents was 10 months. The moricizine hydrochloride and placebo arms of the trial were continued in the NHLBI-sponsored CAST II. In this randomized, double-blind trial, patients with asymptomatic, non-life-threatening ventricular arrhythmias who had had a myocardial infarction within 4 days to 90 days and left ventricular ejection fraction less than or equal to 0.4 prior to enrollment were evaluated. The average duration of treatment with moricizine hydrochloride in this study was 18 months. The study was discontinued because of the unlikely possibility of demonstrating a benefit toward improved survival with moricizine hydrochloride and because of an evolving adverse trend after long-term treatment, although there was no statistical significance versus placebo.

The applicability of the CAST results to other populations (eg, those without recent myocardial infarction) is uncertain. Considering the known proarrhythmic properties of moricizine hydrochloride and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of moricizine hydrochloride, as well as other antiarrhythmic agents, should be reserved for patients with life-threatening ventricular arrhythmias .

Considering the known proarrhythmic properties of moricizine and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of moricizine, as well as other antiarrhythmic agents, should be reserved for patients with life-threatening ventricular arrhythmias .

Commonly used brand name(s):

In the U.S.

Ethmozine

Available Dosage Forms:

Tablet

Therapeutic Class: Antiarrhythmic, Group I

Uses For moricizine

Moricizine belongs to the group of medicines known as antiarrhythmics. It is used to correct irregular or rapid heartbeats to a normal rhythm by making the heart tissue less sensitive.

There is a chance that moricizine may cause new or make worse existing heart rhythm problems when it is used. Since other antiarrhythmic medicines have been shown to cause severe problems in some patients, moricizine is only used to treat serious heart rhythm problems. Discuss this possible effect with your doctor.

moricizine was available only with your doctor’s prescription.

Effective August 28, 2007, the manufacturer will discontinue Ethmozine® (moricizine) due to lack of demand for the product. If you are taking moricizine right now, do not stop taking it or any other medicines until you have talked with your doctor. Your doctor may have special instructions for tapering you off of moricizine slowly. You or your doctor can contact the manufacturer at 1-800-828-2088 and choose the option “Medical Information” if you have questions .

Before Using moricizine

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 moricizine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to moricizine 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

Studies on moricizine have been done only in adult patients, and there is no specific information comparing use of moricizine in children with use in other age groups.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of moricizine in the elderly with use in other age groups, although the risk of some unwanted effects may be increased.

Pregnancy

	Pregnancy Category	Explanation
All Trimesters	B	Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

Interactions with Medicines

Using moricizine 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.

Cisapride
Sparfloxacin

Using moricizine 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.

Alatrofloxacin
Balofloxacin
Ciprofloxacin
Clinafloxacin
Enoxacin
Fleroxacin
Flumequine
Gatifloxacin
Gemifloxacin
Grepafloxacin
Levofloxacin
Lidocaine
Lomefloxacin
Moxifloxacin
Norfloxacin
Ofloxacin
Pefloxacin
Prilocaine
Procainamide
Prulifloxacin
Rufloxacin
Sparfloxacin
Temafloxacin
Tosufloxacin
Vardenafil

Using moricizine 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.

Diltiazem
Warfarin

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. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of moricizine

Take moricizine exactly as directed by your doctor, even though you may feel well. Do not take more or less of it than your doctor ordered.

moricizine works best when there is a constant amount in the blood. To help keep the amount constant, do not miss any doses. Also, it is best to take each dose at evenly spaced times day and night. For example, if you are to take 3 doses a day, doses should be spaced about 8 hours apart. If you need help in planning the best times to take your medicine, check with your health care professional.

Dosing

The dose of moricizine 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 moricizine. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):
- For irregular heartbeat (arrhythmias):
  - Adults—600 to 900 milligrams (mg) a day. This is divided into three doses and taken every eight hours.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of moricizine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. 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.

Precautions While Using moricizine

It is important that your doctor check your progress at regular visits to make sure the medicine is working properly. This will allow changes to be made in the amount of medicine you are taking, if necessary.

Your doctor may want you to carry a medical identification card or bracelet stating that you are using moricizine.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking moricizine.

Moricizine may cause some people to become dizzy or lightheaded. Make sure you know how you react to moricizine before you drive, use machines, or do anything else that could be dangerous if you are dizzy.

moricizine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

Chest pain
fast or irregular heartbeat
shortness of breath
swelling of the feet or lower legs

Rare

Fever (sudden, high)

More common

Dizziness

Less common

Blurred vision
diarrhea
dry mouth
headache
nausea or vomiting
nervousness
numbness or tingling in the arms or legs or around the mouth
pain in the arms or legs
stomach pain
trouble with sleeping
unusual tiredness or weakness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Advanced,M

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