Morphine

What is morphine?

Morphine is an opioid medicine used to control pain. Morphine is available in many forms that can be taken by mouth:

• Fast-acting 10-mg, 15-mg, and 30-mg tablets
• A fast-acting 2 mg/ml blue liquid
• Long-acting 15-mg, 30-mg, 60-mg, and 100-mg white tablets and a 200-mg aqua-blue oblong tablet (known as MS Contin^® or Oramorph SR^®)
• Long-acting pellet-filled 20-mg, 30-mg, 50-mg and 60-mg capsules (known as Kadian^®)

Morphine is also available in a clear liquid given by vein (IV).

How to give morphine

• If you are only taking the fast-acting form of morphine, you will probably need to take the medicine every 2-6 hours to relieve pain. Keep a record of the number of tablets or the amount of liquid medicine that you take each day. Take this record to the clinic. This record will help your doctor give you the best possible pain control.
• If you are taking both the fast-acting and long-acting forms of morphine, you may only need to take the fast-acting form occasionally for “breakthrough” pain.
• If you are taking the long-acting form of morphine, you must take this on a regular schedule to receive the best pain relief. Long-acting morphine is usually taken every 8 to 12 hours.
• Do not cut, chew, or crush the long-acting tablets (MS Contin^® or Oramorph SR^®). Swallow the tablets whole.
• For the long-acting pellet-filled capsule (Kadian^®), you may swallow the capsules whole or empty the capsule contents (pellets) on soft food (like applesauce, ice cream, or pudding). The food should be room temperature or cooler. Swallow the food without chewing. The entire serving of soft food must be eaten to receive the full dose of morphine. Rinse and swallow after eating the food to make sure all the pellets have been swallowed.
• Follow these guidelines if you have a gastrostomy tube (G tube):
  • Open the capsule and sprinkle the pellets into a medicine cup.
  • Open the end of the G tube and flush it with 5 ml of water.
  • Pinch the G tube.
  • Pour the pellets carefully into the port of the G tube.
  • Rinse the pellets into the G tube by dripping 5 ml of water on top of the pellets. Let the mixture of pellets and water flow into the patient by gravity (do not force it).
  • Flush the G tube with another 5 ml of water.
  • Resume your G tube feeding.
• If stomach upset occurs, take morphine with food.
• Morphine may be given to you by IV using a portable pump. This portable pump may have a button that you can push to give yourself medicine when you have pain. The pump will count the number of times you push the button. It will count how much medicine you receive each day. See “Do you know… About patient controlled analgesia (PCA).”

Possible side effects of morphine

Early

• Feeling drowsy
• Nausea
• Slower than normal rates of breathing
• Low blood pressure

Later (usually more than a day after treatment starts)

• Constipation
• Itching and hives
• Feeling drowsy; sedation
• Feeling dizzy
• Nausea and vomiting
• Mood changes (feeling sadder or happier than usual)
• Dry mouth
• Fainting
• Problems urinating

These are the most common side effects, but there may be others. Please report all side effects to the doctor or nurse.

In case of a severe side effect or reaction, call the doctor, nurse, or pharmacist at 595-3300. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 once the call is connected.

Special instructions for morphine

• If you have any of the side effects listed above, most should decrease after you have taken morphine for a couple of days. Tell your doctor if the side effects increase while you are taking this medicine. It may mean you need less morphine.
• If you are taking this medicine regularly, do not stop this medicine until the doctor tells you to do so. Stopping morphine without slowly decreasing the dose can lead to diarrhea, headache, sweating, muscle cramps, trouble sleeping, nausea, vomiting, or feeling restless.
• This medicine may cause you to feel dizzy and drowsy. Do not operate heavy equipment or drive a car until you see how this medicine affects you.
• If you have not slept well because of your pain, you may sleep more during the first few days of taking this medicine to “catch up” on missed sleep.
• If you are taking this medicine regularly, then you should increase your fluid and fiber intake to help prevent constipation. Tell your doctor or nurse if you have not had a bowel movement in 3 to 5 days. You may need to take a stool softener or laxative to relieve your constipation.
• If you have taken morphine for a long time, your doctor may slowly decrease your dose to wean you off morphine. During this time, watch for a sudden onset of diarrhea, headache, sweating, muscle cramps, trouble sleeping, nausea, vomiting, or feeling restless. If these symptoms occur, call your doctor right away. It could mean your dose is being decreased too fast.
• Other medicines can increase the drowsy feeling caused by morphine. These medicines include:
  • Alcohol (found in many over-the-counter cough and cold medicines)
  • Diphenhydramine (over-the-counter Benadryl^®)
  • Promethazine
  • Diazepam or lorazepam
  • Antidepressants (such as amitriptyline)
  • Medicines used to treat seizures (such as phenytoin, carbamazepine, gabapentin, phenobarbital, and valproic acid)
• Always tell your doctor if you are taking these medicines or if you start taking any new medicine while taking morphine.
• This medicine can increase the risk of falls.