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Morphine Sul 10mg Rect Suppository

Manufacturer PERRIGO Active Ingredient Morphine Suppositories(MOR feen) Pronunciation MOR-feen
WARNING: This is an opioid drug. Opioid drugs can put you at risk for drug use disorder. These can lead to overdose and death. You will be watched closely while taking this drug.Severe breathing problems may happen with this drug. The risk is highest when you first start taking this drug or any time your dose is raised. These breathing problems can be deadly. Call your doctor right away if you have slow, shallow, or trouble breathing. Even one dose of this drug may be deadly if it is taken by someone else or by accident, especially in children. If this drug is taken by someone else or by accident, get medical help right away.Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.Do not take more than what your doctor told you to take. Do not take more often or for longer than you were told. Doing any of these things may raise the chance of severe side effects.Severe side effects have happened when opioid drugs were used with benzodiazepines, alcohol, marijuana, other forms of cannabis, or street drugs. This includes severe drowsiness, breathing problems, and death. Benzodiazepines include drugs like alprazolam, diazepam, and lorazepam. If you have questions, talk with the doctor.Many drugs interact with this drug and can raise the chance of side effects like deadly breathing problems. Talk with your doctor and pharmacist to make sure it is safe to use this drug with all of your drugs.Get medical help right away if you feel very sleepy, very dizzy, or if you pass out. Caregivers or others need to get medical help right away if the patient does not respond, does not answer or react like normal, or will not wake up.If you are pregnant or plan to get pregnant, talk with your doctor right away about the benefits and risks of using this drug during pregnancy. Using this drug for a long time during pregnancy may lead to withdrawal in the newborn baby. Withdrawal in the newborn can be life-threatening if not treated. @ COMMON USES: It is used to manage pain when non- opioid pain drugs do not treat your pain well enough or you cannot take them.
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Drug Class
Opioid analgesic
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Pharmacologic Class
Opioid agonist
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Pregnancy Category
Category C
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FDA Approved
Jan 1970
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DEA Schedule
Schedule II

Overview

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What is this medicine?

Morphine is a strong pain medicine called an opioid. It works in your brain and nervous system to change how your body feels and responds to pain. This medicine comes as a suppository that you insert into your rectum.
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How to Use This Medicine

Taking Your Medication Correctly

To use this medication safely and effectively, follow your doctor's instructions and read all the information provided. When using the suppository rectally, make sure to:

Wash your hands before and after handling the suppository
 Chill the suppository in the refrigerator or run it under cold water if it's too soft
Remove the foil wrapper and insert the suppository into the rectum, pointed end first, without handling it excessively
 Wet the suppository before insertion to facilitate comfortable use

Storing and Disposing of Your Medication

To maintain the quality and safety of your medication:

Store it at room temperature, protected from light and moisture
 Keep it in a dry place, away from bathrooms and areas where children or pets may access it
Store it in a secure, locked location to prevent accidental ingestion or misuse
 Dispose of unused or expired medication by throwing it away, unless instructed otherwise by your pharmacist or healthcare provider
Do not flush medication down the toilet or drain, unless specifically advised to do so
 Check with your pharmacist about potential drug take-back programs in your area

Managing Missed Doses

If you take this medication on a regular schedule and miss a dose:

Take the missed dose as soon as you remember
 If it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule
Do not take two doses at the same time or take extra doses
 If you take this medication as needed, do not take it more frequently than directed by your doctor.
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Lifestyle & Tips

  • To prevent constipation, which is a common side effect, drink plenty of fluids, eat fiber-rich foods, and use stool softeners or laxatives as recommended by your doctor.
  • Avoid alcohol and other sedating medications while taking morphine, as this can increase the risk of serious side effects like extreme drowsiness and breathing problems.
  • Do not drive or operate heavy machinery until you know how this medicine affects you, as it can cause dizziness and drowsiness.
  • Store this medicine securely away from children and pets, as accidental ingestion can be fatal.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: 10 mg to 30 mg rectally every 4 hours as needed for pain
Dose Range: 10 - 30 mg

Condition-Specific Dosing:

acutePain: Initial dose 10-20 mg rectally every 4 hours, titrate to effect.
chronicPain: Individualize dose based on patient's prior opioid exposure and pain severity. May require higher doses for opioid-tolerant patients.
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Pediatric Dosing

Neonatal: Not established
Infant: Not established
Child: Not generally recommended for routine use; if used, highly individualized and under strict medical supervision. Dosing typically 0.2-0.5 mg/kg/dose every 4 hours, not to exceed 15 mg/dose.
Adolescent: Similar to adult dosing, but start with lower doses and titrate carefully.
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Dose Adjustments

Renal Impairment:

Mild: Monitor for increased effects; consider dose reduction.
Moderate: Reduce initial dose by 25-50%; extend dosing interval. Monitor closely for respiratory depression and sedation.
Severe: Reduce initial dose by 50-75%; extend dosing interval. Avoid if possible due to accumulation of active metabolites (M6G).
Dialysis: Morphine and its active metabolite (M6G) are dialyzable. Administer after dialysis. Significant dose reduction required.

Hepatic Impairment:

Mild: Monitor for increased effects; consider dose reduction.
Moderate: Reduce initial dose by 25-50%. Monitor closely for respiratory depression and sedation.
Severe: Reduce initial dose by 50-75%. Avoid if possible due to reduced clearance.

Pharmacology

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Mechanism of Action

Morphine is an opioid agonist that acts primarily at the mu-opioid receptors in the central nervous system (CNS) and other tissues. Its analgesic effects are mediated by binding to these receptors, leading to inhibition of pain transmission, alteration of pain perception, and induction of euphoria.
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Pharmacokinetics

Absorption:

Bioavailability: 20-70% (highly variable via rectal route)
Tmax: 1-4 hours (rectal)
FoodEffect: Not applicable for rectal administration.

Distribution:

Vd: 3-5 L/kg
ProteinBinding: 20-35%
CnssPenetration: Yes

Elimination:

HalfLife: 2-4 hours (parent drug); M6G has a longer half-life, especially in renal impairment.
Clearance: Approximately 10-20 mL/min/kg
ExcretionRoute: Renal (primarily as glucuronide conjugates)
Unchanged: <10%
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Pharmacodynamics

OnsetOfAction: 30-60 minutes (rectal)
PeakEffect: 1-2 hours (rectal)
DurationOfAction: 4-5 hours (rectal)

Safety & Warnings

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BLACK BOX WARNING

RISK OF ADDICTION, ABUSE, AND MISUSE; RESPIRATORY DEPRESSION; NEONATAL OPIOID WITHDRAWAL SYNDROME; ACCIDENTAL INGESTION; and CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS.

Addiction, Abuse, and Misuse: Morphine exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing and monitor all patients regularly for the development of these behaviors and conditions.

Respiratory Depression: Serious, life-threatening, or fatal respiratory depression may occur. Monitor for respiratory depression, especially during initiation of morphine or following a dose increase.

Neonatal Opioid Withdrawal Syndrome: Prolonged use of morphine during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Accidental Ingestion: Accidental ingestion of even one dose of morphine, especially by children, can result in a fatal overdose of morphine.

Concomitant Use with Benzodiazepines or Other CNS Depressants: Concomitant use of opioids with benzodiazepines or other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.
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Side Effects

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
 Signs of low blood sugar, including:
+ Dizziness
+ Headache
+ Feeling sleepy
+ Feeling weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
Severe dizziness or fainting
 Chest pain or pressure, or a rapid heartbeat
Confusion
 Breathing difficulties, including:
+ Slow or shallow breathing
+ Noisy breathing
+ Sleep apnea (breathing problems during sleep)
Seizures
 Severe constipation or stomach pain, which may indicate a severe bowel problem
Depression or other mood changes
 Swelling in the arms or legs
Fever, chills, or sore throat
 Pain while urinating
Abnormal sensations, such as burning, numbness, or tingling
 Serotonin syndrome, a potentially life-threatening condition that may occur when taking this medication with certain other drugs. Symptoms include:
+ Agitation
+ Balance problems
+ Confusion
+ Hallucinations
+ Fever
+ Rapid or abnormal heartbeat
+ Flushing
+ Muscle twitching or stiffness
+ Seizures
+ Shivering or shaking
+ Excessive sweating
+ Severe diarrhea, nausea, or vomiting
+ Severe headache
Adrenal gland problems, which may occur with long-term opioid use. Symptoms include:
+ Extreme fatigue or weakness
+ Fainting
+ Severe dizziness
+ Nausea or vomiting
+ Decreased appetite
 Hormonal changes, which may occur with long-term opioid use. Symptoms include:
+ Decreased interest in sex
+ Fertility problems
+ Missed menstrual periods
+ Ejaculation problems

Other Possible Side Effects

While many people may not experience side effects or may only have mild side effects, it's essential to be aware of the following:

Dizziness
 Drowsiness
Fatigue
 Weakness
Dry mouth
 Constipation
Diarrhea
 Stomach pain
Nausea or vomiting
 Decreased appetite
Headache
 Anxiety
* Excessive sweating

If you experience any of these side effects or any other symptoms that concern you, contact your doctor or seek medical attention. Not all side effects are listed here, so if you have questions or concerns, don't hesitate to reach out to your doctor.

Reporting Side Effects

You can report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Your doctor can also provide guidance on managing side effects and offer medical advice.
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Seek Immediate Medical Attention If You Experience:

  • Slow or shallow breathing
  • Extreme drowsiness or difficulty waking up
  • Dizziness or lightheadedness when standing up
  • Severe constipation or abdominal pain
  • Confusion or unusual thoughts
  • Blue-tinged lips or fingernails
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Before Using This Medicine

Before taking this medication, it is essential to inform your doctor about the following:

Any allergies you have, including allergies to this drug, its components, or other substances. Be sure to describe the allergic reaction you experienced, including the symptoms that occurred.
 Certain health conditions, such as:
+ Respiratory problems, including asthma, breathing difficulties, or sleep apnea
+ Elevated carbon dioxide levels in the blood
+ Stomach or bowel obstruction or narrowing
If you have taken specific medications for depression or Parkinson's disease within the last 14 days, including isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may increase the risk of severely high blood pressure
 If you are currently taking any of the following medications: buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine

Please note that this is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist to ensure safe use. Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor.
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Precautions & Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

When starting this medication, avoid driving and other activities that require alertness until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.

Do not combine this medication with other strong pain relievers or use it with a pain patch without first consulting your doctor. If your pain worsens, you become more sensitive to pain, or experience new pain after taking this medication, contact your doctor immediately. Adhere to the prescribed dosage and do not exceed it.

Long-term or high-dose use of this medication can lead to tolerance, where the drug's effectiveness decreases, and higher doses may be required to achieve the same pain relief. If you find that this medication is no longer working as well as it did initially, consult your doctor. Do not increase the dosage without medical guidance.

Prolonged or regular use of opioid medications like this one can result in dependence. Suddenly reducing the dose or stopping the medication can increase the risk of withdrawal or other severe complications. Before decreasing the dose or discontinuing this medication, consult your doctor and follow their instructions. Report any increased pain, mood changes, suicidal thoughts, or other adverse effects to your doctor.

Avoid consuming alcohol or products containing alcohol while taking this medication, as it can lead to unsafe and potentially fatal interactions.

This medication may increase the risk of seizures, particularly in individuals with a history of seizures. Discuss your risk of seizures with your doctor.

If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.

Breastfeeding mothers should inform their doctor, as this medication can pass into breast milk and potentially harm the baby. If your baby appears excessively sleepy, limp, or has breathing difficulties, seek medical attention immediately.
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Overdose Information

Overdose Symptoms:

  • Pinpoint pupils
  • Slowed or stopped breathing
  • Extreme drowsiness or unresponsiveness
  • Limp muscles
  • Cold, clammy skin
  • Blue discoloration of lips and fingernails
  • Loss of consciousness

What to Do:

If you suspect an overdose, call 911 immediately. Administer naloxone if available and trained to do so. Stay with the person until emergency medical help arrives. Call 1-800-222-1222 for Poison Control.

Drug Interactions

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Contraindicated Interactions

  • Monoamine Oxidase Inhibitors (MAOIs) within 14 days (risk of serotonin syndrome or severe respiratory depression)
  • Patients with significant respiratory depression
  • Patients with acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
  • Known or suspected paralytic ileus
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Major Interactions

  • Other CNS depressants (e.g., benzodiazepines, other opioids, alcohol, sedatives, hypnotics, general anesthetics, phenothiazines, tranquilizers, skeletal muscle relaxants): Increased risk of respiratory depression, profound sedation, coma, and death.
  • Serotonergic drugs (e.g., SSRIs, SNRIs, TCAs, triptans, mirtazapine, tramadol, linezolid): Risk of serotonin syndrome.
  • Anticholinergic drugs (e.g., atropine, scopolamine, tricyclic antidepressants): Increased risk of urinary retention and severe constipation/paralytic ileus.
  • Mixed agonist/antagonist opioids (e.g., pentazocine, nalbuphine, butorphanol): May reduce morphine's analgesic effect and/or precipitate withdrawal symptoms.
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Moderate Interactions

  • Diuretics: Opioids may reduce the efficacy of diuretics by inducing the release of antidiuretic hormone.
  • P-glycoprotein inhibitors (e.g., quinidine, verapamil, amiodarone): May increase morphine exposure.
  • P-glycoprotein inducers (e.g., rifampin, carbamazepine, phenytoin): May decrease morphine exposure.
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Minor Interactions

  • Cimetidine: May inhibit morphine metabolism, leading to increased morphine levels (less clinically significant).

Monitoring

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Baseline Monitoring

Pain intensity and characteristics

Rationale: To establish baseline and guide initial dosing.

Timing: Prior to initiation of therapy

Respiratory rate and depth

Rationale: To assess risk of respiratory depression.

Timing: Prior to initiation of therapy

Level of consciousness/sedation

Rationale: To assess baseline mental status and risk of over-sedation.

Timing: Prior to initiation of therapy

Bowel function

Rationale: To assess baseline and anticipate opioid-induced constipation.

Timing: Prior to initiation of therapy

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Routine Monitoring

Pain intensity and relief

Frequency: Regularly, especially after dose adjustments (e.g., 30-60 min after dose, then every 2-4 hours)

Target: Patient-specific pain goal (e.g., reduction by 2 points on 0-10 scale)

Action Threshold: Inadequate pain control: consider dose increase or alternative strategy.

Respiratory rate and depth

Frequency: Every 1-4 hours initially, then as clinically indicated

Target: Typically >10-12 breaths/min, regular rhythm

Action Threshold: <10 breaths/min, shallow breathing, or signs of hypoventilation: hold dose, consider naloxone, notify prescriber.

Sedation level (e.g., Pasero Opioid-Induced Sedation Scale)

Frequency: Every 1-4 hours initially, then as clinically indicated

Target: Awake and alert or mildly drowsy, easily aroused

Action Threshold: Difficult to arouse or unarousable: hold dose, consider naloxone, notify prescriber.

Bowel function

Frequency: Daily

Target: Regular bowel movements (e.g., every 1-2 days)

Action Threshold: No bowel movement for >2-3 days: initiate or escalate laxative regimen.

Blood pressure and heart rate

Frequency: As clinically indicated, especially with initial doses or dose increases

Target: Within patient's normal range

Action Threshold: Significant hypotension or bradycardia: notify prescriber.

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Symptom Monitoring

  • Respiratory depression (slow, shallow breathing)
  • Excessive sedation/drowsiness
  • Nausea and vomiting
  • Constipation
  • Dizziness
  • Pruritus (itching)
  • Urinary retention
  • Confusion
  • Hypotension

Special Patient Groups

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Pregnancy

Prolonged use during pregnancy can lead to neonatal opioid withdrawal syndrome (NOWS) in the newborn, which can be life-threatening. Use only if the potential benefit justifies the potential risk to the fetus. Monitor neonates for signs of NOWS.

Trimester-Specific Risks:

First Trimester: Limited data, but potential for congenital malformations with first-trimester opioid exposure cannot be ruled out.
Second Trimester: Risk of NOWS increases with prolonged use.
Third Trimester: High risk of NOWS if used chronically. May cause respiratory depression in the neonate if used close to delivery.
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Lactation

Morphine is excreted into breast milk. Monitor infants for signs of sedation, respiratory depression, poor feeding, and poor weight gain. A single dose is generally considered compatible with breastfeeding, but chronic use is not recommended.

Infant Risk: Moderate risk (L3). Potential for infant sedation, respiratory depression, and withdrawal symptoms if maternal dose is high or prolonged.
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Pediatric Use

Use with extreme caution. Rectal administration may be preferred in some situations (e.g., vomiting, NPO), but absorption is variable. Dosing must be individualized and carefully titrated based on age, weight, and clinical response. Not recommended for routine use in neonates or infants.

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Geriatric Use

Elderly patients may be more sensitive to the analgesic and adverse effects of morphine, particularly respiratory depression. Start with lower doses and titrate slowly. Monitor closely for sedation, respiratory depression, and constipation. Reduced renal and hepatic function are common in the elderly, requiring dose adjustments.

Clinical Information

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Clinical Pearls

  • Rectal absorption of morphine can be highly variable, leading to unpredictable plasma concentrations and clinical effects. Close monitoring is essential.
  • The 10 mg rectal suppository is a common starting dose, but individual patient response and tolerance vary widely. Titrate slowly to effect.
  • Opioid-induced constipation is a nearly universal side effect; proactive management with stool softeners and laxatives should be initiated concurrently with morphine therapy.
  • Morphine-6-glucuronide (M6G), an active metabolite, accumulates in renal impairment and contributes significantly to analgesic and adverse effects. Dose reduction is critical in patients with kidney dysfunction.
  • Due to the risk of respiratory depression, ensure naloxone is readily available, especially in outpatient settings where morphine is prescribed.
  • Educate patients and caregivers on safe storage, proper administration, and signs of overdose.
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Alternative Therapies

  • Other opioid analgesics (e.g., oxycodone, hydromorphone, fentanyl, tramadol)
  • Non-opioid analgesics (e.g., NSAIDs, acetaminophen)
  • Adjuvant analgesics (e.g., gabapentin, pregabalin, tricyclic antidepressants for neuropathic pain)
  • Regional anesthesia or nerve blocks
  • Non-pharmacological pain management (e.g., physical therapy, acupuncture, cognitive behavioral therapy)
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Cost & Coverage

Average Cost: Varies widely, typically $10-$50 per 10 suppositories
Generic Available: Yes
Insurance Coverage: Tier 1 or 2 (generic)
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General Drug Facts

If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, do not share your medication with others or take someone else's medication.

This medication is accompanied by a Medication Guide, which is a patient fact sheet that provides crucial information. It is vital to read this guide carefully and review it again each time your prescription is refilled. If you have any questions or concerns about this medication, consult your doctor, pharmacist, or other healthcare provider.

In the event of an overdose, a medication called naloxone can be administered to help treat the condition. Discuss obtaining and using naloxone with your doctor or pharmacist. If you suspect an overdose has occurred, seek immediate medical attention, even if naloxone has been administered. Be prepared to provide detailed information about the overdose, including the substance taken, the amount, and the time it occurred.