Morphine Sul 80mg ER Caps (24h)
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.Swallow whole. Do not chew, break, crush, or dissolve before swallowing. Doing these things can cause very bad side effects and death.If you open this drug and sprinkle the contents on applesauce, do not crush or chew the pellets before swallowing. Doing so can cause severe side effects and death.Make sure you have the right drug; there is more than one strength. A lower strength may not ease pain well enough. A higher strength could lead to accidental overdose and death.Certain strengths of this drug may only be used by people who have been taking drugs like this drug and are used to their effects. The use of these strengths by people who have not been taking drugs like this drug may cause very bad and sometimes deadly breathing problems. Talk with the doctor. @ COMMON USES: It is used to manage pain when daily pain treatment is needed for a long time. It is for use when non-opioid pain drugs do not treat your pain well enough or you cannot take them.
Drug Class
Opioid Analgesic
Pharmacologic Class
Opioid Agonist
Pregnancy Category
Category C
FDA Approved
Sep 1996
DEA Schedule
Schedule II
Overview
What is this medicine?
Morphine extended-release is a strong pain medicine (an opioid) that works in your brain to change how your body feels and responds to pain. The 'extended-release' part means it's designed to release the medicine slowly over 24 hours, so you only take it once a day for long-lasting pain relief. It's used for severe, ongoing pain that needs around-the-clock treatment and cannot be managed by other pain medicines.
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. Take this medication by mouth only, with or without food. If it causes stomach upset, take it with food to help minimize discomfort.
Important Administration Instructions
Do not inject or snort this medication, as this can lead to severe side effects, including respiratory problems and overdose, which can be fatal.
Take your medication at the same time every day to maintain a consistent level in your system.
Swallow the medication whole; do not chew, break, crush, or dissolve it before swallowing, as this can also cause severe side effects and death.
Do not use this medication for quick pain relief or on an as-needed basis.
* If you are taking this medication for pain relief after surgery, ensure you have been using similar medications beforehand.
Special Instructions for Difficulty Swallowing
If you have trouble swallowing the medication whole, you may sprinkle the contents onto applesauce. If you do this, swallow the mixture immediately without chewing. Rinse your mouth to ensure all the contents have been swallowed.
Using a Feeding Tube
Some brands of this medication can be administered through a specific type of feeding tube, while others cannot. Consult your pharmacist to determine if your brand can be given via a feeding tube.
Storage and Disposal
Store your medication at room temperature, protected from light and in a dry place. Avoid storing it in a bathroom. Keep the medication in a secure location where children cannot see or reach it, and where others cannot access it. A locked box or secure area can help keep the medication safe. Also, keep all medications away from pets.
Missing a Dose
If you miss a dose, skip it and return to your regular dosing schedule. Do not take two doses at the same time or extra doses to make up for the missed dose.
To use this medication safely and effectively, follow your doctor's instructions and read all the information provided. Take this medication by mouth only, with or without food. If it causes stomach upset, take it with food to help minimize discomfort.
Important Administration Instructions
Do not inject or snort this medication, as this can lead to severe side effects, including respiratory problems and overdose, which can be fatal.
Take your medication at the same time every day to maintain a consistent level in your system.
Swallow the medication whole; do not chew, break, crush, or dissolve it before swallowing, as this can also cause severe side effects and death.
Do not use this medication for quick pain relief or on an as-needed basis.
* If you are taking this medication for pain relief after surgery, ensure you have been using similar medications beforehand.
Special Instructions for Difficulty Swallowing
If you have trouble swallowing the medication whole, you may sprinkle the contents onto applesauce. If you do this, swallow the mixture immediately without chewing. Rinse your mouth to ensure all the contents have been swallowed.
Using a Feeding Tube
Some brands of this medication can be administered through a specific type of feeding tube, while others cannot. Consult your pharmacist to determine if your brand can be given via a feeding tube.
Storage and Disposal
Store your medication at room temperature, protected from light and in a dry place. Avoid storing it in a bathroom. Keep the medication in a secure location where children cannot see or reach it, and where others cannot access it. A locked box or secure area can help keep the medication safe. Also, keep all medications away from pets.
Missing a Dose
If you miss a dose, skip it and return to your regular dosing schedule. Do not take two doses at the same time or extra doses to make up for the missed dose.
Lifestyle & Tips
- Take exactly as prescribed; do not crush, chew, or dissolve the capsules as this can lead to a rapid release of a potentially fatal dose.
- Swallow capsules whole. If unable to swallow, some brands allow sprinkling contents on soft food (e.g., applesauce) and swallowing immediately without chewing.
- Do not drink alcohol while taking this medication, as it can increase the risk of serious side effects, including breathing problems and sedation.
- Avoid driving or operating heavy machinery until you know how this medication affects you, as it can cause dizziness and drowsiness.
- Store in a secure place away from children and pets, as accidental ingestion can be fatal.
- Do not share this medication with anyone else.
- Discuss all other medications, including over-the-counter drugs, herbal supplements, and illicit drugs, with your doctor to avoid dangerous interactions.
- Maintain adequate hydration and fiber intake, and use stool softeners/laxatives as prescribed to manage constipation.
Available Forms & Alternatives
Available Strengths:
- Morphine Sulf Rect 20mg Suppository
- Morphine Sul 10mg Rect Suppository
- Morphine Sulf Rect 30mg Suppository
- Morphine Sulf Rect 5mg Suppository
- Morphine Sul 15mg ER Tabs (12h)
- Morphine Sul 30mg ER Tabs (12h)
- Morphine Sul 60mg ER Tabs (12h)
- Morphine Sulf 100mg ER Tabs (12h)
- Morphine Sulf 200mg ER Tabs (12h)
- Morphine Sul 50mg/ml Inj , 20ml
- Morphine Sul 50mg/ml Inj, 50ml
- Morphine Sul 1mg/ml Inj 10ml
- Morphine Sul 30mg Imm Rel Tab
- Morphine Sul 15mg Imm Rel Tab
- Morphine Sul 10mg/5ml(2mg/ml) Sol
- Morphine Sul 20mg/5ml(4mg/ml) Sol
- Morphine Sulf 100mg/5ml(20mg/ml)sol
- Morphine Sul 10mg/ml Inj, 1ml
- Morphine Sul 10mg ER Caps (24h)
- Morphine Sul 30mg ER Caps (24h)
- Morphine Sul 60mg ER Caps (24h)
- Morphine Sul 45mg ER Caps (24h)
- Morphine Sul 75mg ER Caps (24h)
- Morphine Sul 90mg ER Caps (24h)
- Morphine Sulf 120mg ER Caps (24h)
- Morphine Sul 80mg ER Caps (24h)
- Morphine Sul 30mg ER Caps (24h)
- Morphine Sul 20mg ER Caps(24h)
- Morphine Sul 50mg ER Caps(24h)
- Morphine Sulf 100mg ER Caps (24h)
- Morphine Sul 4mg/ml Inj, 1ml
- Morphine Sulf 100mg/5ml(20mg/ml)sol
- Morphine Sulfate 2mg/ml Inj 1ml
- Morphine Sulf Inj 4mg/ml 1ml Syr
- Morphine Sul 2mg/ml Inj 1ml
- Morphine Sul 8mg/ml Inj, 1ml
- Morphine Sul 30mg ER Tabs
- Morphine Sulfate 4mg/ml Inj, 1ml
- Morphine Sulfate 10mg/ml Inj, 1ml
- Morphine Sul 0.5mg/ml Inj, 5ml
- Morphine Sul 8mg/ml Inj, 1ml Vial
Dosing & Administration
Adult Dosing
Standard Dose:
Individualized, typically 20 mg to 100 mg orally every 24 hours for opioid-tolerant patients. 80 mg is a high dose for established chronic pain.
Dose Range:
20 - 100 mg
Condition-Specific Dosing:
opioid_naive:
Not for opioid-naive patients. Initial dose for opioid-naive patients should be much lower (e.g., 10-20 mg every 24 hours for ER, or immediate-release titration).
conversion_from_other_opioids:
Requires careful calculation of total daily opioid dose and conversion to morphine equivalent, then conversion to ER formulation. Consult equianalgesic tables.
Pediatric Dosing
Neonatal:
Not established for extended-release formulations. Use immediate-release with extreme caution.
Infant:
Not established for extended-release formulations. Use immediate-release with extreme caution.
Child:
Not established for extended-release formulations. Use immediate-release with caution and dose by weight.
Adolescent:
Not established for extended-release formulations. If used, start with lowest possible dose and titrate carefully, only in opioid-tolerant patients.
Dose Adjustments
Renal Impairment:
Mild:
Monitor for increased adverse effects. Dose reduction may be necessary.
Moderate:
Significant dose reduction (e.g., 25-50% of usual dose) and extended dosing interval may be required due to accumulation of active metabolites (morphine-6-glucuronide).
Severe:
Contraindicated or extreme caution with significant dose reduction (e.g., 50-75% or more) and extended dosing interval. Avoid if possible. Close monitoring for respiratory depression and sedation.
Dialysis:
Morphine and its metabolites are partially dialyzable. Administer after dialysis. Significant dose reduction and extended interval required. Close monitoring.
Hepatic Impairment:
Mild:
Monitor for increased adverse effects. Dose reduction may be necessary.
Moderate:
Dose reduction (e.g., 25-50% of usual dose) and extended dosing interval may be required. Monitor closely for sedation and respiratory depression.
Severe:
Significant dose reduction (e.g., 50-75% or more) and extended dosing interval required. Avoid if possible. Close monitoring for respiratory depression and sedation.
Pharmacology
Mechanism of Action
Morphine is an opioid agonist that primarily interacts with mu-opioid receptors in the central nervous system (CNS) and other tissues. Activation of these receptors produces analgesia, sedation, euphoria, and respiratory depression. It also affects gastrointestinal motility, causing constipation.
Pharmacokinetics
Absorption:
Bioavailability:
Variable (oral bioavailability ranges from 20-40% due to significant first-pass metabolism). Extended-release formulations aim for sustained absorption.
Tmax:
Approximately 6-12 hours for extended-release capsules (e.g., Kadian, Avinza).
FoodEffect:
Food may increase the rate and extent of absorption for some ER formulations (e.g., Kadian, Avinza), leading to higher peak concentrations. Should be taken consistently with or without food.
Distribution:
Vd:
Approximately 3-4 L/kg (large volume of distribution, indicating extensive tissue distribution).
ProteinBinding:
Low (approximately 20-35%).
CnssPenetration:
Yes, readily crosses the blood-brain barrier.
Elimination:
HalfLife:
Terminal half-life of morphine is approximately 2-4 hours, but for extended-release formulations, the effective half-life for sustained release is longer, allowing for once-daily dosing (e.g., 10-12 hours for Kadian).
Clearance:
Approximately 15-30 mL/min/kg.
ExcretionRoute:
Primarily renal (approximately 90% as glucuronide conjugates, 10% as unchanged drug).
Unchanged:
Approximately 2-10% of the dose is excreted unchanged in urine.
Pharmacodynamics
OnsetOfAction:
Delayed for extended-release formulations (e.g., 1-2 hours or more). Not suitable for acute pain.
PeakEffect:
Approximately 6-12 hours for extended-release capsules.
DurationOfAction:
Up to 24 hours for once-daily extended-release formulations.
Safety & Warnings
BLACK BOX WARNING
RISK OF ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS; and ALCOHOL INTERACTION. Morphine extended-release 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. Serious, life-threatening, or fatal respiratory depression may occur. Accidental ingestion of even one dose can result in a fatal overdose. Prolonged use during pregnancy can result in neonatal opioid withdrawal syndrome. Concomitant use with benzodiazepines or other CNS depressants may result in profound sedation, respiratory depression, coma, and death. Avoid use of alcohol.
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 immediately or seek emergency 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
+ Difficulty 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 or weak
+ Shaking
+ Rapid 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 serious bowel problem
Depression or other mood changes
Swelling in the arms or legs
Fever, chills, or sore throat
Painful urination
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
+ Vomiting
+ Decreased appetite
Hormonal changes, which may occur with long-term opioid use. Symptoms include:
+ Decreased sex drive
+ Fertility problems
+ Irregular menstrual periods
+ Ejaculation problems
Other Possible Side Effects
While many people may not experience any side effects or only mild ones, it's essential to be aware of the following potential side effects:
Dizziness
Drowsiness
Fatigue
Weakness
Dry mouth
Constipation
Diarrhea
Stomach pain
Nausea
Vomiting
Decreased appetite
Headache
Anxiety
Excessive sweating
If you experience any of these side effects or any other unusual symptoms, contact your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
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 immediately or seek emergency 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
+ Difficulty 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 or weak
+ Shaking
+ Rapid 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 serious bowel problem
Depression or other mood changes
Swelling in the arms or legs
Fever, chills, or sore throat
Painful urination
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
+ Vomiting
+ Decreased appetite
Hormonal changes, which may occur with long-term opioid use. Symptoms include:
+ Decreased sex drive
+ Fertility problems
+ Irregular menstrual periods
+ Ejaculation problems
Other Possible Side Effects
While many people may not experience any side effects or only mild ones, it's essential to be aware of the following potential side effects:
Dizziness
Drowsiness
Fatigue
Weakness
Dry mouth
Constipation
Diarrhea
Stomach pain
Nausea
Vomiting
Decreased appetite
Headache
Anxiety
Excessive sweating
If you experience any of these side effects or any other unusual symptoms, contact your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Slow or shallow breathing
- Extreme drowsiness or difficulty waking up
- Dizziness or lightheadedness when standing up
- Confusion
- Blue lips or fingernails
- Severe constipation or abdominal pain
- Signs of allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing)
- Signs of serotonin syndrome (agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, diarrhea)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Respiratory problems like asthma, breathing difficulties, or sleep apnea
+ Elevated carbon dioxide levels in the blood
+ Stomach or bowel blockage or narrowing
Recent use (within the last 14 days) of specific medications for depression or Parkinson's disease, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure
Current use of certain medications, including buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine
* If you are breastfeeding, as you should not breastfeed while taking this medication
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Respiratory problems like asthma, breathing difficulties, or sleep apnea
+ Elevated carbon dioxide levels in the blood
+ Stomach or bowel blockage or narrowing
Recent use (within the last 14 days) of specific medications for depression or Parkinson's disease, such as isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline, as this may lead to severely high blood pressure
Current use of certain medications, including buprenorphine, butorphanol, linezolid, methylene blue, nalbuphine, or pentazocine
* If you are breastfeeding, as you should not breastfeed while taking this medication
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without consulting your doctor.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other activities that require you to be alert. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.
Interactions with Other Medications
Do not take this medication with other strong pain medications or use a pain patch without first consulting your doctor.
Monitoring Your Pain
If your pain worsens, you become more sensitive to pain, or experience new pain after taking this medication, contact your doctor immediately. Do not exceed the prescribed dose.
Tolerance and Dependence
Long-term or high-dose use of this medication may lead to tolerance, where the medication becomes less effective, and higher doses are needed to achieve the same effect. If you experience a decrease in the medication's effectiveness, consult your doctor. Do not take more than the prescribed dose.
Additionally, regular use of opioid medications like this one can cause dependence. If you need to reduce the dose or stop taking this medication, consult your doctor first, as suddenly stopping or lowering the dose can increase the risk of withdrawal or other severe problems. Follow your doctor's instructions carefully and report any increased pain, mood changes, suicidal thoughts, or other adverse effects.
Allergies and Interactions
If you are allergic to sulfites, discuss this with your doctor, as some products contain sulfites. Avoid consuming alcohol or products containing alcohol while taking this medication, as this can lead to unsafe and potentially fatal effects.
Seizure Risk
This medication may increase the risk of seizures, particularly in individuals with a history of seizures. Consult your doctor to determine if you are at a higher risk of seizures while taking this medication.
Special Considerations for Older Adults
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other activities that require you to be alert. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.
Interactions with Other Medications
Do not take this medication with other strong pain medications or use a pain patch without first consulting your doctor.
Monitoring Your Pain
If your pain worsens, you become more sensitive to pain, or experience new pain after taking this medication, contact your doctor immediately. Do not exceed the prescribed dose.
Tolerance and Dependence
Long-term or high-dose use of this medication may lead to tolerance, where the medication becomes less effective, and higher doses are needed to achieve the same effect. If you experience a decrease in the medication's effectiveness, consult your doctor. Do not take more than the prescribed dose.
Additionally, regular use of opioid medications like this one can cause dependence. If you need to reduce the dose or stop taking this medication, consult your doctor first, as suddenly stopping or lowering the dose can increase the risk of withdrawal or other severe problems. Follow your doctor's instructions carefully and report any increased pain, mood changes, suicidal thoughts, or other adverse effects.
Allergies and Interactions
If you are allergic to sulfites, discuss this with your doctor, as some products contain sulfites. Avoid consuming alcohol or products containing alcohol while taking this medication, as this can lead to unsafe and potentially fatal effects.
Seizure Risk
This medication may increase the risk of seizures, particularly in individuals with a history of seizures. Consult your doctor to determine if you are at a higher risk of seizures while taking this medication.
Special Considerations for Older Adults
If you are 65 or older, use this medication with caution, as you may be more susceptible to side effects.
Overdose Information
Overdose Symptoms:
- Pinpoint pupils
- Slowed or stopped breathing (respiratory depression)
- Extreme drowsiness or unresponsiveness
- Limp muscles
- Cold, clammy skin
- Blue discoloration of lips and fingernails (cyanosis)
- Slowed heart rate
- Low blood pressure
- Coma
- Death
What to Do:
Seek immediate emergency medical attention. Call 911 or your local emergency number. Administer naloxone if available and trained to do so. Call 1-800-222-1222 (Poison Control Center) for additional guidance.
Drug Interactions
Contraindicated Interactions
- Concomitant use with benzodiazepines or other CNS depressants in patients for whom alternatives are inadequate (Black Box Warning due to risk of profound sedation, respiratory depression, coma, and death).
- Monoamine Oxidase Inhibitors (MAOIs) or within 14 days of MAOI discontinuation (risk of serotonin syndrome, respiratory depression, coma, death).
- Patients with significant respiratory depression, acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment.
- Known or suspected paralytic ileus.
Major Interactions
- Other CNS depressants (e.g., alcohol, sedatives, hypnotics, anxiolytics, tranquilizers, general anesthetics, phenothiazines, other opioids): Increased risk of respiratory depression, profound sedation, coma, death.
- Serotonergic drugs (e.g., SSRIs, SNRIs, TCAs, triptans, mirtazapine, tramadol): Risk of serotonin syndrome.
- Mixed agonist/antagonist opioids (e.g., pentazocine, nalbuphine, butorphanol): May reduce morphine's analgesic effect and/or precipitate withdrawal symptoms.
- Opioid antagonists (e.g., naltrexone, naloxone): Precipitate acute opioid withdrawal.
- Diuretics: Opioids may reduce the efficacy of diuretics by causing release of antidiuretic hormone.
Moderate Interactions
- Anticholinergics (e.g., atropine, scopolamine): Increased risk of urinary retention and/or severe constipation/paralytic ileus.
- Muscle relaxants: Enhanced neuromuscular blocking effects and increased risk of respiratory depression.
- P-glycoprotein (P-gp) inhibitors (e.g., quinidine, verapamil, amiodarone, clarithromycin, cyclosporine, ritonavir): May increase morphine exposure and effects.
- P-gp inducers (e.g., rifampin, carbamazepine, phenytoin): May decrease morphine exposure and effects.
Minor Interactions
- Cimetidine: May inhibit morphine metabolism, leading to increased morphine levels (minor effect).
Monitoring
Baseline Monitoring
Pain assessment (intensity, quality, location)
Rationale: To establish baseline pain level and guide initial dosing.
Timing: Prior to initiation of therapy.
Respiratory rate and depth
Rationale: To assess baseline respiratory function and identify risk for respiratory depression.
Timing: Prior to initiation of therapy.
Level of consciousness/sedation
Rationale: To assess baseline mental status and identify risk for excessive sedation.
Timing: Prior to initiation of therapy.
Bowel function
Rationale: To assess baseline bowel habits and anticipate opioid-induced constipation.
Timing: Prior to initiation of therapy.
Renal and hepatic function tests (CrCl, LFTs)
Rationale: To identify potential impairment that may necessitate dose adjustment due to altered metabolism/elimination of morphine and its active metabolites.
Timing: Prior to initiation of therapy, especially in elderly or those with comorbidities.
Risk assessment for opioid use disorder (OUD)
Rationale: To identify patients at higher risk for addiction and implement appropriate monitoring and mitigation strategies.
Timing: Prior to initiation of therapy.
Routine Monitoring
Pain assessment
Frequency: Regularly, especially during titration and with any change in dose; at least monthly for stable patients.
Target: Acceptable pain control with tolerable side effects.
Action Threshold: Uncontrolled pain or unacceptable side effects warrant dose adjustment or re-evaluation.
Respiratory rate and depth
Frequency: Frequently during initiation and titration; periodically for stable patients.
Target: Normal respiratory rate (e.g., 12-20 breaths/min) with adequate depth.
Action Threshold: Respiratory rate < 10-12 breaths/min, shallow breathing, or signs of hypoventilation require immediate intervention (e.g., naloxone, respiratory support).
Level of consciousness/sedation (e.g., Pasero Opioid-Induced Sedation Scale)
Frequency: Frequently during initiation and titration; periodically for stable patients.
Target: Alert or mildly drowsy, easily aroused.
Action Threshold: Excessive sedation (e.g., difficult to arouse, somnolent) requires immediate intervention (e.g., dose reduction, naloxone).
Bowel function
Frequency: Daily or as needed.
Target: Regular bowel movements (e.g., every 1-2 days).
Action Threshold: Constipation (e.g., no bowel movement for >3 days) requires intervention (e.g., laxatives, stool softeners).
Signs of opioid use disorder (OUD)
Frequency: Regularly, at each visit.
Target: Absence of aberrant drug-related behaviors.
Action Threshold: Signs of OUD (e.g., drug-seeking behavior, escalating use, diversion) require referral for specialized treatment.
Adverse effects (nausea, vomiting, pruritus, dizziness)
Frequency: Regularly, especially during initiation and titration.
Target: Tolerable or absent.
Action Threshold: Persistent or severe adverse effects warrant dose adjustment or alternative therapy.
Symptom Monitoring
- Respiratory depression (slow, shallow breathing, cyanosis)
- Excessive sedation/somnolence
- Dizziness/lightheadedness
- Nausea/vomiting
- Constipation
- Pruritus (itching)
- Confusion/disorientation
- Urinary retention
- Signs of opioid withdrawal (if abruptly discontinued: restlessness, yawning, lacrimation, rhinorrhea, piloerection, sweating, muscle aches, nausea, vomiting, diarrhea, abdominal cramps, increased heart rate and blood pressure)
Special Patient Groups
Pregnancy
Prolonged use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS), which may be life-threatening if not recognized and treated. Morphine crosses the placenta. Use only if the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
First Trimester:
Potential for congenital malformations (e.g., neural tube defects, cardiac defects) if used early in pregnancy, though data are mixed and causality not definitively established.
Second Trimester:
Risk of fetal growth restriction and other adverse outcomes with prolonged use.
Third Trimester:
High risk of neonatal opioid withdrawal syndrome (NOWS) if used chronically. Respiratory depression in the neonate if used close to delivery.
Lactation
Morphine is excreted into breast milk. While levels are generally low, there is a risk of sedation, respiratory depression, and withdrawal symptoms in the breastfed infant. Monitor infants for increased sleepiness, difficulty breathing, or limpness. Use with caution, consider alternative analgesics, or pump and discard milk.
Infant Risk:
L3 (Moderate risk) - Monitor infant for sedation, poor feeding, respiratory depression, and withdrawal symptoms if maternal use is prolonged or high dose.
Pediatric Use
Safety and efficacy of morphine extended-release capsules have not been established in pediatric patients. Use of immediate-release morphine in children requires careful weight-based dosing and close monitoring. Extended-release formulations are generally not recommended due to the risk of overdose from accidental ingestion and difficulty in precise dose titration.
Geriatric Use
Elderly patients may be more sensitive to the analgesic and adverse effects of opioids, including respiratory depression, sedation, and constipation. Start with lower doses and titrate slowly. Monitor renal function closely due to increased risk of M6G accumulation.
Clinical Information
Clinical Pearls
- Morphine ER 80mg is a high dose and should only be used in opioid-tolerant patients with severe chronic pain requiring continuous, around-the-clock opioid analgesia.
- Never crush, chew, or dissolve extended-release morphine capsules, as this can lead to rapid release of a potentially fatal dose.
- Educate patients and caregivers on the safe storage and disposal of opioids to prevent accidental ingestion, especially by children.
- Always have naloxone readily available for patients prescribed high-dose opioids or those at increased risk of overdose.
- Aggressively manage opioid-induced constipation with prophylactic bowel regimens (stimulant laxative + stool softener).
- Monitor for signs of opioid-induced hyperalgesia, especially with long-term, high-dose use, which may manifest as increasing pain despite escalating opioid doses.
- Consider a trial of immediate-release morphine to establish total daily dose and tolerance before converting to an extended-release formulation.
- Taper slowly when discontinuing to avoid withdrawal symptoms.
Alternative Therapies
- Other extended-release opioids (e.g., oxycodone ER, hydromorphone ER, fentanyl transdermal, tapentadol ER, buprenorphine transdermal/buccal)
- Other strong opioid analgesics (e.g., hydromorphone, oxymorphone, fentanyl, methadone)
- Non-opioid analgesics (e.g., NSAIDs, acetaminophen, gabapentin, pregabalin, duloxetine, tricyclic antidepressants) for neuropathic or chronic pain components.
- Interventional pain management (e.g., nerve blocks, spinal cord stimulation)
- Physical therapy, occupational therapy, psychological therapies (e.g., CBT, mindfulness), acupuncture, massage for chronic pain management.
Cost & Coverage
Average Cost:
$300 - $800+ per 30 capsules (80mg ER)
Generic Available:
Yes
Insurance Coverage:
Tier 2 or 3 (often requires prior authorization and/or step therapy due to high cost and abuse potential)
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, 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.
This medication is accompanied by a Medication Guide, 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.