Morphine is used to relieve moderate to severe pain. Morphine extended-release tablets and capsules are only used to relieve severe (around-the-clock) pain that cannot be controlled by the use of other pain medications. Morphine extended-release tablets and capsules should not be used to treat pain that can be controlled by medication that is taken as needed. Morphine is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain.

Morphine comes as a solution (liquid), an extended-release (long-acting) tablet, and as an extended-release (long-acting) capsule to take by mouth. The oral solution is usually taken every 4 hours as needed for pain. MS Contin brand and Arymo ER brand are extended-release tablets that are usually taken every 8 or every 12 hours. Morphabond brand extended-release tablets are usually taken every 12 hours. Kadian brand extended-release capsules are usually taken with or without food every 12 hours or every 24 hours. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand.

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

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

If you are unable to swallow the extended-release capsules (Kadian), you can carefully open a capsule, sprinkle all of the beads that it contains on a spoonful of cold or room temperature applesauce, and swallow the entire mixture immediately without chewing or crushing the beads. Then rinse your mouth with a little water and swallow the water to be sure that you have swallowed all the medication. Do not mix the beads into any other food. Do not save mixtures of medication and applesauce for later.

If you are taking the extended-release tablets (Arymo ER), swallow them one at a time with plenty of water. Swallow the extended-release tablets right after putting it in your mouth. Do not presoak, wet, or lick the extended-release tablets before you put them in your mouth.

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

Do not stop taking morphine without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop taking morphine, you may experience withdrawal symptoms such as restlessness; teary eyes; runny nose; yawning; irritability; anxiety; sweating; difficulty falling asleep or staying asleep; chills; back, muscle, or joint pain; nausea; vomiting; loss of appetite; diarrhea; stomach cramps; weakness; fast heartbeat; or fast breathing.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking morphine,

• tell your doctor and pharmacist if you are allergic to morphine, any other medications, or any of the inactive ingredients in the type of morphine product you plan to take. Ask your pharmacist or check the Medication Guide for a list of the inactive ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention the medications listed in the IMPORTANT WARNING section and any of the following: antihistamines (found in cold and allergy medications); buprenorphine (Belbuca, Butrans, in Suboxone, others); butorphanol; cyclobenzaprine (Amrix); dextromethorphan (found in many cough medications; in Nuedexta); diuretics (‘water pills’); lithium (Lithobid); medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); nalbuphine; pentazocine (Talwin); quinidine (in Nuedexta); 5HT₃ serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); tramadol (Conzip, Ultram, in Ultracet), trazodone (Oleptro); or tricyclic antidepressants (‘mood elevators’) such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Also tell your doctor if you are taking any of the following monoamine oxidase (MAO) inhibitors, or if you have stopped taking them within the past 2 weeks: isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate). Many other medications may also interact with morphine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John’s wort and tryptophan.
• tell your doctor if you have or have ever had any of the conditions mentioned in the IMPORTANT WARNING section or paralytic ileus (condition in which digested food does not move through the intestines). Your doctor may tell you not to take morphine.
• tell your doctor if you have or have ever had a blockage in your stomach or intestines; seizures; difficulty swallowing; prostatic hypertrophy (enlargement of a male reproductive gland); urinary problems; low blood pressure; Addison’s disease (condition in which the adrenal gland does not make enough of certain natural substances) or liver, kidney, pancreas, thyroid, or gallbladder disease.
• tell your doctor if you are breastfeeding.
• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of taking morphine.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking morphine.
• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that morphine may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.
• you should know that morphine may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are taking morphine.

Unless your doctor tells you otherwise, continue your normal diet.

If you are taking morphine tablets or liquid, your doctor will probably tell you to take the medication as needed.

If you have been told to take scheduled doses of the tablets or liquid or if you are taking an extended-release product, take the missed dose as soon as you remember it, and do not take the next dose at your regularly scheduled time. Instead, allow the same amount of time that you usually allow between doses before taking your next dose. If you remember when it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

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

• drowsiness
• stomach pain and cramps
• dry mouth
• headache
• nervousness
• mood changes
• small pupils (black circles in the middle of the eyes
• difficulty urinating or pain when urinating

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

• blue or purple color to the skin
• changes in heartbeat
• agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, nausea, vomiting, or diarrhea
• nausea, vomiting, loss of appetite, weakness, or dizziness
• inability to get or keep an erection
• irregular menstruation
• decreased sexual desire
• seizures
• extreme drowsiness
• fainting
• chest pain
• fever
• hives
• rash
• itching
• swelling of the eyes, face, mouth, lips or throat
• hoarseness
• difficulty breathing or swallowing

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

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). You must immediately dispose of any medication that is outdated or no longer needed through a medicine take-back program. If you do not have a take-back program nearby or one that you can access promptly, flush any morphine extended-release tablets, extended-release capsules, and liquid that are outdated or no longer needed down the toilet so that others will not take them. Talk to your pharmacist about the proper disposal of your medication.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

While taking morphine, you should talk to your doctor about having a rescue medication called naloxone readily available (e.g., home, office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. Your doctor may also prescribe you naloxone if you are living in a household where there are small children or someone who has abused street or prescription drugs. You should make sure that you and your family members, caregivers, or the people who spend time with you know how to recognize an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer’s website to get the instructions. If symptoms of an overdose occur, a friend or family member should give the first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Symptoms of overdose may include the following:

• slow, shallow, or irregular breathing
• difficulty breathing
• sleepiness
• unable to respond or wake up
• limp muscles
• cold, clammy skin
• small pupils
• slow heartbeat
• blurred vision
• nausea
• fainting

Keep all appointments with your doctor and laboratory. Your doctor may order certain lab tests to check your body’s response to morphine.

Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are taking morphine.

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

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