Morphine Sulfate, Oral/Rectal

What are other names for this medicine?

Type of medicine: narcotic analgesic (painkiller)

Generic and brand names: morphine sulfate, oral; morphine sulfate, rectal; Avinza; Kadian; MS Contin; MSIR; MS/S; Oramorph SR; RMS Suppositories; Roxanol; Roxanol 100

What is this medicine used for?

This medicine is a narcotic analgesic.

It is used to relieve moderate to severe pain.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine
• a lung or breathing disorder such as asthma or COPD
• stomach or intestinal blockage, severe diarrhea, or constipation
• a head injury or brain tumor
• acute pancreatitis or biliary tract disease
• Addison's disease
• heart disease or irregular heartbeat
• liver or kidney disease
• low blood pressure
• enlarged prostrate gland or trouble urinating
• problems with alcohol or drug abuse
• seizures
• thyroid problems

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Take it only for the condition for which it was prescribed. Do not take more of it or take it longer than prescribed. Taking too much of this medicine may be habit-forming or may lead to overdose.

If you have the rectal suppository form of this medicine, wash your hands, then remove the foil wrapper. Moisten the suppository with water or water-based lubricating jelly. If the suppository is too soft to insert, run cold water over it or put it in ice water until it is firm. If it is too dry or hard, moisten it with warm water. Lie on your left side and bend your right knee up toward your chest. Gently push the suppository into your rectum so it is deep enough not to come out.

If you have the controlled (sustained) release form of this medicine, do not break, chew, or crush the tablets or capsules. Swallow them whole.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: extreme drowsiness, pinpoint pupils, confusion, cold clammy skin, shallow breathing, fainting, breathing that stops, coma.

What should I watch out for?

You may need to take this medicine for a long time. If you need to take this medicine for more than a few days, do not stop taking it suddenly. You may have to reduce your dosage gradually to avoid withdrawal symptoms. Follow your healthcare provider's instructions.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you are taking this medicine.

This medicine increases the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol or take other medicines unless your healthcare provider approves.

This medicine may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert.

You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may lessen this effect. Also, drinking alcohol may increase this effect.

Contact your healthcare provider if your condition does not improve in a few days or if it gets worse.

This medicine may make you constipated. Drinking lots of water, exercising, and taking more fiber may help. You may need to take a laxative or stool softener while taking this medicine. Talk with healthcare provider or pharmacist about this.

Adults over the age of 65 may be at greater risk for side effects from this medicine. Talk with your healthcare provider about this.

Important notice: Taking an overdose of this medicine can cause very serious problems. If you think you have taken an overdose, get medical care right away.

This medicine is a controlled substance. It is illegal for you to give it to anyone else.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you are unable to reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; tightness in your chest; trouble breathing; swelling of your lips, tongue or throat).

Serious (report these to your healthcare provider right away): Seizures, hallucinations (seeing or hearing things that are not there), severe muscle weakness, decreased urination, trembling, fast or slow heartbeat, fainting, slow or shallow breathing, confusion, pinpoint pupils of the eyes, blurred vision.

Other: Dizziness, drowsiness, lightheadedness, nausea, vomiting, constipation, itching, headache, dry mouth, sweating, loss of appetite, change in sexual desire or ability.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• antianxiety medicines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), triazolam (Halcion), temazepam (Restoril), flurazepam (Dalmane), and oxazepam (Serax)
• antihistamines such as diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril), and chlorpheniramine (Chlor-Trimeton)
• antinausea medicines such as prochlorperazine (Compazine), and promethazine (Phenergan)
• antipsychotic medicines such as chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), perphenazine, trifluoperazine (Stelazine), thioridazine, haloperidol (Haldol), clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa)
• barbiturates such as phenobarbital, butabarbital (Butisol), and pentobarbital (Nembutal)
• antiseizure medicines such as carbamazepine (Tegretol), primidone (Mysoline), gabapentin (Neurontin), felbamate (Felbatol), lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), valproic acid (Depacon, Depakene, Depakote), oxcarbazepine (Trileptal), tiagabine (Gabitril), and phenytoin (Dilantin)
• blood pressure medicines such diltiazem (Cardizem, Dilacor, Tiamate, Tiazac), nicardipine (Cardene), nifedipine (Procardia, Adalat), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), Verapamil (Calan, Isoptin, Verelan), atenolol (Tenormin), acebutolol (Sectral), betaxolol (Kerlone), carteolol, bisoprolol (Zebeta), pindolol, metoprolol (Lopressor, Toprol XL), timolol, sotalol (Betapace), nadolol (Corgard), propranolol (Inderal), labetalol (Normodyne, Trandate), and carvedilol (Coreg)
• cimetidine (Tagamet, Tagamet HB 200)
• cyclosporine (Neoral, Sandimmune)
• dextroamphetamine (Dexedrine, Dextrostat, Adderall)
• herbs with sedative effects such as kava, St. John's wort, gotu kola, and valerian
• MAO inhibitor antidepressants such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• metformin (Glucophage)
• muscle relaxants such as cyclobenzaprine (Flexeril), carisoprodol (Soma), tizanidine (Zanaflex), methocarbamol (Robaxin), and baclofen (Lioresal)
• naltrexone (ReVia)
• other narcotic analgesics such as codeine, hydrocodone (Vicodin, Lortab), oxycodone (Percocet, Tylox, OxyContin), morphine (MS Contin), propoxyphene (Darvocet N-100), pentazocine (Talwin), meperidine (Demerol), fentanyl (Duragesic patches, Actiq lozenges), methadone (Dolophine), and hydromorphone (Dilaudid)
• medicines to treat AIDS such as amprenavir (Agenerase), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), stavudine (Zerit), delavirdine (Rescriptor), zidovudine (Retrovir), and saquinavir (Invirase, Fortovase)
• rifabutin (Mycobutin) and rifampin (Rifadin, Rimactane)
• sleeping pills such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and chloral hydrate
• SSRI antidepressants such as sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), venlafaxine (Effexor), and fluvoxamine
• tricyclic antidepressants such as amitriptyline, nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), desipramine (Norpramin), and doxepin (Sinequan).
• warfarin (Coumadin)

Do not drink alcohol while you are taking this medicine. Alcohol increases the way this medicine is absorbed and may be life-threatening.

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.