Morphine

Morphine is a potent opioid analgesic used to treat acute or severe pain when alternative pain relief medicines are not effective or not tolerated. It is a Schedule II controlled substance available as tablets, extended-release tablets and capsules, an oral liquid, suppositories, and in injectable formulations.

Because of the risks of addiction, abuse, misuse, overdose, and death, which can occur at any dosage or duration and persist over the course of therapy, reserve morphine for use in patients for whom alternative treatment options are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain.

Morphine belongs to the drug class called opiate (narcotic) analgesics and is a full opioid agonist that is relatively selective for the mu-opioid receptor. However, it can bind to other opioid receptors at higher doses. The exact way it works is unknown, but it is thought to alter how the brain and nervous system respond to pain.

Morphine may also be abused and should not be used in patients with a history of substance abuse or opioid abuse. Abuse may lead to severe psychological or physical dependence.

Morphine first gained FDA approval in 1984.

Take morphine exactly as prescribed by your doctor. Follow the directions on your prescription label and read all medication guides or instruction sheets. Never use morphine in larger amounts or for longer than prescribed. Tell your doctor if you feel an increased urge to use more morphine.

• Never crush a pill to inhale the powder or inject it into your vein. This could result in death.
• Swallow the extended-release capsule or tablet whole to avoid exposure to a potentially fatal overdose. Do not crush, chew, break, open, or dissolve.
• Measure liquid medicine with the supplied measuring device (not a kitchen spoon).
• Call your doctor if your symptoms do not improve or if they get worse.
• You should not stop using morphine suddenly. Stopping suddenly may cause withdrawal symptoms. Ask your doctor before stopping the medicine.
• Your dose needs may change if you switch to a different brand, strength, or form of this medicine. Avoid medication errors by using only the medicine your doctor prescribes.
• Never share opioid medicine with another person, especially someone with a history of drug addiction. MISUSE CAN CAUSE ADDICTION, OVERDOSE, OR DEATH. Keep the medicine where others cannot get to it. Selling or giving away this medicine is against the law.

Do not keep leftover medicine. Just one dose can cause death for someone using it accidentally or improperly. Ask your pharmacist about a drug take-back program, or flush the unused medicine down the toilet.

Store tightly closed at room temperature, away from moisture, heat, and light. Keep your medicine in a place where no one can use it improperly.

Morphine carries a Boxed Warning for serious and life-threatening risks.

Morphine can put you at risk for overdose and death. Even if you take your dose correctly as prescribed, you are at risk for opioid addiction, abuse, and misuse that can lead to death.

Get emergency help or call 911 right away if you take too much morphine. When you first start taking morphine, when your dose is changed, or if you take too much (overdose), serious or life-threatening breathing problems that can lead to death may occur. Ask your healthcare provider about medicines like naloxone or nalmefene that can be used in an emergency to reverse an opioid overdose.

Do not take morphine if you have severe asthma or breathing problems, a blockage in your stomach or intestines, or a bowel obstruction called paralytic ileus.

Serious, life-threatening, or fatal respiratory depression may occur, especially during initiation or following a dosage increase. To reduce the risk of respiratory depression, proper dosing and titration of morphine are essential.

If you receive preservative-free morphine by epidural or intrathecal injection (into the spinal fluid), you must be observed in a fully equipped and staffed medical setting for at least 24 hours after the initial dose, as delayed and life-threatening breathing problems can occur.

Misuse or accidental ingestion of morphine can cause addiction, overdose, or death, especially in a child or other person using the medicine without a prescription. Keep the medication in a place where others cannot get to it.

Taking Morphine during pregnancy may cause life-threatening withdrawal symptoms in the newborn.

Severe drowsiness, decreased awareness, breathing problems, coma, and death can occur if you use morphine with alcohol or with other drugs that cause drowsiness or slow your breathing, such as benzodiazepines, gabapentinoids (gabapentin or pregabalin), or other central nervous system (CNS) depressants, such as street drugs. Tell your healthcare provider about all the medications you take.

The FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for opioid analgesics to balance benefits against risks of addiction and misuse. Prescribers must complete REMS-compliant education, counsel patients on safe use and disposal, ensure patients read Medication Guides, and consider patient-prescriber agreements to enhance safety.

Addiction and Misuse: Morphine carries a real risk of addiction and misuse, even when taken as prescribed. Your doctor will assess your risk beforehand and monitor you regularly. If you have a personal or family history of substance abuse or mental health conditions, make sure to discuss this with your doctor.

Breathing Problems: Morphine can cause serious, potentially fatal breathing difficulties, particularly when starting treatment or after a dose increase. Never give this medication to children, as even a single dose can be fatal. If you notice slow or shallow breathing in yourself or someone else, call 911 immediately.

Overdose Reversal Agent: Ask your doctor or pharmacist about keeping an emergency overdose reversal medication (such as naloxone) at home, especially if you live with children or others at risk.

Mixing with Other Medications or Alcohol: Combining morphine with alcohol, sleeping tablets, anxiety medications, or other sedatives can be life-threatening. Always tell your doctor about everything you are taking.

Pregnancy: Taking morphine long-term during pregnancy can cause withdrawal symptoms in your newborn. Speak with your doctor immediately if you are pregnant or planning to become pregnant.

REMS Education: Your healthcare provider is required to counsel you on safe use, storage, and disposal of this medication every time it is prescribed. Read the Medication Guide provided by your pharmacist.

Increased Pain Sensitivity (OIH): In some cases, morphine can paradoxically make pain worse. If your pain increases despite taking your medication, let your doctor know rather than assuming you need a higher dose.

Lung Conditions and Vulnerable Patients: Morphine is contraindicated in unmonitored patients with severe asthma. Patients with chronic lung disease, the elderly, or those who are frail are at higher risk of breathing complications and require extra monitoring.

MAO Inhibitors: Do not take morphine if you are currently taking or have taken an MAO inhibitor (a type of antidepressant) within the last 14 days. The combination can cause severe, life-threatening reactions.

Adrenal Insufficiency: Long-term use can affect your adrenal glands. Tell your doctor if you experience persistent nausea, fatigue, dizziness, or low blood pressure.

Low Blood Pressure: Morphine can cause a sudden drop in blood pressure, particularly when standing up. Take care when changing positions and report any dizziness or fainting to your doctor.

Head Injuries or Brain Conditions: Morphine is not suitable for patients with raised intracranial pressure, brain tumours, or impaired consciousness. It can mask important neurological symptoms.

Stomach and Digestive Issues: Morphine is not safe for patients with bowel obstruction. It can also affect the digestive system more broadly. Report any difficulty swallowing, chest discomfort, or worsening stomach symptoms.

Seizures: If you have a seizure disorder, morphine may increase seizure frequency. Your doctor should monitor your condition closely.

Stopping Morphine: Never stop taking morphine suddenly. Your doctor will gradually reduce your dose to avoid withdrawal symptoms.

Driving and Operating Machinery: Morphine can impair your concentration and reaction time. Do not drive or operate heavy machinery until you know how this medication affects you.

You should not take this medicine if you have ever had an allergic reaction to morphine or other opioid medicines or if you have:

• severe asthma or breathing problems;
• a stomach or bowel obstruction (including paralytic ileus); or
• if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, or tranylcypromine.

To make sure morphine is safe for you, tell your doctor if you have ever had:

• chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;
• a head injury, brain tumor, high pressure inside the skull, or seizures;
• a drug or alcohol addiction or mental illness;
• urination problems;
• problems with your bile duct, gallbladder, pancreas, thyroid, or adrenal gland; or
• liver or kidney disease.

Tell your doctor if you also use stimulant medicine, other opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. An interaction with morphine could cause a serious condition called serotonin syndrome.

Pregnancy

Morphine may harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. If you use morphine during pregnancy, your baby could be born with life-threatening withdrawal symptoms and may need medical treatment for several weeks.

Long-term morphine use may affect fertility in men or women. Pregnancy could be harder to achieve while either parent is using this medicine.

Breastfeeding

Morphine passes into breast milk and may harm your baby. Breastfeeding is not recommended during treatment with some forms of morphine. If you do breastfeed, carefully observe your baby for increased sleepiness (more than usual), breathing difficulties, or limpness, and seek immediate medical care if you notice these signs.

Common side effects

The most common side effects of morphine are constipation, nausea, drowsiness, light-headedness, dizziness, sedation, vomiting, and sweating.

Serious morphine side effects

Get emergency medical help if you have signs of an allergic reaction to morphine: hives, difficult breathing, swelling of your face, lips, tongue, or throat.

Morphine can slow or stop your breathing, and death may occur, especially if you drink alcohol or use other drugs that cause drowsiness or slow breathing. A person caring for you should give naloxone and/or seek emergency medical attention if you have slow breathing with long pauses, blue colored lips, or if you are hard to wake up.

Morphine may cause other serious side effects. Call your doctor at once if you have:

• slow heart rate, weak pulse, fainting, slow breathing (breathing may stop);
• chest pain, fast or pounding heartbeats;
• extreme drowsiness, feeling like you might pass out; or
• decreased adrenal gland hormones - nausea, vomiting, stomach pain, loss of appetite, feeling tired or light-headed, muscle or joint pain, skin discoloration, craving salty foods.

Serious breathing problems may be more likely in older adults and people who are debilitated or have wasting syndrome or chronic breathing disorders.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Since morphine is used for pain, you are not likely to miss a dose. Skip any missed dose if it is almost time for your next dose. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose can be fatal, especially in a child or a person using opioid medicine without a prescription. Overdose symptoms may include severe drowsiness, pinpoint pupils, slow breathing, or no breathing.

Your doctor may recommend that you get naloxone (a medicine to reverse an opioid overdose) and keep it with you at all times. A person caring for you can give the naloxone if you stop breathing or don't wake up. Your caregiver must still get emergency medical help and may need to perform CPR (cardiopulmonary resuscitation) on you while waiting for help to arrive.

Anyone can buy naloxone from a pharmacy or local health department. Make sure any person caring for you knows where you keep naloxone and how to use it.

Do not drink alcohol. Dangerous side effects or death could occur.

Avoid driving or hazardous activity until you know how morphine will affect you. Dizziness or drowsiness can cause falls, accidents, or severe injuries. Also, avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Many other drugs can be dangerous when used with opioid medicine. Tell your doctor if you also use:

• Medicine for allergies, cough, asthma, blood pressure, motion sickness, irritable bowel, or overactive bladder;
• Other opioid pain medicine or prescription cough medicine;
• cimetidine, verapamil, quinidine;
• Sleep medicine, muscle relaxers, or other drugs that make you drowsy; or
• A benzodiazepine sedative like Valium, Klonopin, or Xanax
• Mixed agonist/antagonist and partial agonist opioid analgesics: Avoid use with morphine because they may reduce the analgesic effect of morphine or precipitate withdrawal symptoms
• Monoamine Oxidase Inhibitors (MAOIs): Can potentiate the effects of morphine. Avoid concomitant use in patients receiving MAOIs or within 14 days of stopping treatment with an MAOI
• Gabapentinoids, such as gabapentin or pregabalin
• Serotonergic drugs, such as fluoxetine, tramadol, or amitriptyline. Concomitant use may result in serotonin syndrome. Discontinue morphine if serotonin syndrome is suspected.

This list is not complete and many other drugs may affect morphine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.