WARNING: ADDICTION, ABUSE, and MISUSE; LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; and NEONATAL OPIOID WITHDRAWAL SYNDROME
Addiction, Abuse, and Misuse
Morphine sulfate extended-release tablets expose 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 morphine sulfate extended-release tablets, and monitor all patients regularly for the development of these behaviors or conditions [see Warnings and Precautions].
Life-Threatening Respiratory Depression
Serious, life-threatening, or fatal respiratory depression may occur with use of morphine sulfate extended-release tablets. Monitor for respiratory depression, especially during initiation of morphine sulfate extended-release tablets or following a dose increase. Instruct patients to swallow morphine sulfate extended-release tablets whole; crushing, chewing, or dissolving morphine sulfate extended-release tablets can cause rapid release and absorption of a potentially fatal dose of morphine [see Warnings and Precautions].
Accidental ingestion of even one dose of morphine sulfate extended-release tablets, especially by children, can result in a fatal overdose of morphine [see Warnings and Precautions].
Neonatal Opioid Withdrawal Syndrome
Prolonged use of morphine sulfate extended-release tablets 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 [see Warnings and Precautions].
Morphine Sulfate Extended-Release Tablets are for oral use and contain morphine sulfate, an agonist at the mu-opioid receptor.
Morphine sulfate extended-release tablets are indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
Limitations of Use
- Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the the greater risks of overdose and death with extended-release opioid formulations, reserve morphine sulfate extended-release tablets for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain.
- Morphine sulfate extended-release tablets are not indicated as an as-needed (prn) analgesic.
Media Articles Related to Morphine
FDA Okays Morphine Sulfate (Arymo ER) for Chronic Pain
Source: Medscape Anesthesiology Headlines [2017.01.10]
The new extended-release morphine sulfate C-II uses novel technology that makes it difficult to misuse and abuse, the company said.
Narrow Indication for Abuse-Deterrent Morphine
Source: MedPage Today Neurology [2017.01.10]
(MedPage Today) -- Market exclusivity puts intranasal labeling off-limits
A Scientist Shares His Battle to Withdraw From Painkillers
Source: Medscape General Surgery Headlines [2017.01.13]
Travis Rieder spent more than four weeks in hospitals and nearly lost his foot after a van ran a stop sign and struck his motorcycle on Memorial Day weekend in 2015.
Reuters Health Information
Yoga May Ease Pain, Up Function in Chronic Low Back Pain
Source: Medscape NeurologyHeadlines [2017.01.13]
Yoga may improve function and lessen pain in patients with chronic, nonspecific low back pain, a new Cochrane review suggests.
Medscape Medical News
Open-label Placebo Treatment in Chronic Low Back Pain
Source: Medscape Anesthesiology Headlines [2017.01.12]
Can a placebo treatment improve chronic low-back pain--even when the patient is aware that it's a placebo?
Published Studies Related to Morphine
Influence of Morphine on Pharmacokinetics and Pharmacodynamics of Ticagrelor in
Patients with Acute Myocardial Infarction (IMPRESSION): study protocol for a
randomized controlled trial. 
BACKGROUND: Ticagrelor is an oral platelet P2Y12 receptor antagonist which is
recommended for patients suffering from myocardial infarction, both with and
without persistent ST segment elevation... DISCUSSION: This study is expected to provide essential evidence-based data on
the impact of morphine on the absorption of ticagrelor in patients with
myocardial infarction as well as to shed some light on the suspected connection
between morphine use and antiplatelet activity of ticagrelor in the same group of
Efficacy and safety of sublingual fentanyl orally disintegrating tablet at doses
determined from oral morphine rescue doses in the treatment of breakthrough
cancer pain. 
evaluate the efficacy and safety of sublingual fentanyl tablet... CONCLUSIONS: Patients treated with strong opioid analgesics at fixed intervals
Evaluation of a single-dose, extended-release epidural morphine formulation for
pain control after lumbar spine surgery. 
DepoDur, an extended-release epidural morphine, has been used effectively for
postoperative pain control following many orthopaedic and general surgery
procedures and has provided prolonged analgesia when compared with Duramorph. The
goal of this article was to compare the safety and analgesic efficacy of DepoDur
versus Duramorph after lumbar spine surgery...
Morphine decreases clopidogrel concentrations and effects: a randomized,
double-blind, placebo-controlled trial. 
effects on platelets... CONCLUSIONS: Morphine delays clopidogrel absorption, decreases plasma levels of
Transversus abdominis plane block versus perioperative intravenous lidocaine
versus patient-controlled intravenous morphine for postoperative pain control
after laparoscopic colorectal surgery: study protocol for a prospective,
randomized, double-blind controlled clinical trial. 
BACKGROUND: Despite the laparoscopic approach becoming the standard in colorectal
surgery, postoperative pain management for minimally invasive surgery is still
mainly based on strategies that have been established for open surgical
procedures... DISCUSSION: Recognizing the importance of a multimodal approach for perioperative
pain management, we aim to investigate whether a transversus abdominis plane
block delivers superior pain control in comparison to perioperative intravenous
lidocaine and patient-controlled intravenous analgesia with morphine alone.
Clinical Trials Related to Morphine
The Median Effective Dose (ED50) of Paracetamol and Morphine : A Study of Interaction Study [Completed]
The aim of our study is to define the median effective analgesic doses (ED50) of
paracetamol, morphine, and their combination and determination the nature of their
interaction administered IV for postoperative pain after moderate painful surgery using
up-and-down and isobolographic methods.
Patients-Controlled Epidural Analgesia After Gastric Bypass for Morbid Obesity Using Morphine-Levobupivacaine Regimens [Completed]
Adequate postoperative analgesia can facilitate recovery following gastric bypass surgery
for morbid obesity. The efficacy and safety of intravenous patient - controlled analgesia
has been studied, but up to date no data are available concerning the use of thoracic
epidural patient-controlled analgesia regarding the use of levobupivacaine combined with
morphine in morbidly obese patients. The investigators' aim in this prospective,
randomized, double-blinded study was to compare the analgesic effectiveness, the dose
requirements and side effects of thoracic epidural patient controlled analgesia 0. 1% and
0. 2% levobupivacaine combined with a continuous epidural administration of morphine, with or
without a loading dose, after open gastric bypass for morbid obesity.
A Comparison of Morphine and Morphine Plus Dexmedetomidine in Chronic Cancer Pain [Recruiting]
The purpose of this study is to determine whether dexmedetomidine added to morphine is
effective in the treatment of chronic cancer pain.
Continuous Pre-uterine Wound Infiltration Versus Intrathecal Morphine for Postoperative Analgesia After Cesarean Section [Recruiting]
The cesarean section is considered as a painful surgery during the post operative period.
Mothers may need to move immediately after the surgery to take care of their babies. This
may increase the risk of major pain and chronic pain. Thus, excellent postoperative
analgesia is required so that mothers do not experience pain in caring for their baby.
Currently, several techniques have been developed to manage postoperative pain related to
c-section scar such as intrathecal morphine during spinal anesthesia or continuous
pre-peritoneal wound infiltration. The comparison between anesthetic techniques has never
been performed and it is still not know if the combination of intrathecal morphine plus
continuous pre-peritoneal wound infiltration provide a synergistic or additional effect on
Ketamine Associated With Morphine PCA After Total Hip Arthroplasty [Completed]
Ketamine (an analgesic drug often associated with morphine in the treatment of Opioid
Induced Hyperalgesia) is often mixed in Morphine PCA syringe. We make the hypothesis that
ketamine administrated separately via a continuous infusion, could induced a better
We will perform a randomised double blind study to determine the best infusion mode of
intravenous ketamine, associated with morphine in PCA syringe or alone in continuous
Reports of Suspected Morphine Side Effects
Completed Suicide (135),
Toxicity TO Various Agents (118),
Cardio-Respiratory Arrest (83),
Cardiac Arrest (78),
Respiratory Arrest (77),
Drug Abuse (68),
Drug Ineffective (41),
Somnolence (38), more >>
PATIENT REVIEWS / RATINGS / COMMENTS
Based on a total of 2 ratings/reviews, Morphine has an overall score of 5.50. The effectiveness score is 7 and the side effect score is 6. The scores are on ten point scale: 10 - best, 1 - worst.
Morphine review by 47 year old male patient
|Overall rating:|| || |
|Effectiveness:|| || Considerably Effective|
|Side effects:|| || No Side Effects|
|Condition / reason:|| || post surgery extreme pain |
|Dosage & duration:|| || 15 mg IR Tablets taken 2 x per day for the period of long term|
|Other conditions:|| || umbilical hernia |
|Other drugs taken:|| || too many to list |
|Benefits:|| || Relief of chronic intermittent pain. Also, relief from chronic ( post ) repeated surgery and repeated hospitalizations.|
|Side effects:|| || No side effects even after prolonged use for intermittent chronic pain. Have been taking 15 mg tablets on and off ( not taken every day ) for over 2 years. |
|Comments:|| || Currently being used on a as needed basis for chronic pain. Also, used for sudden onset of severe pain from post surgical complications. |
Morphine review by 64 year old female patient
|Overall rating:|| || |
|Effectiveness:|| || Moderately Effective|
|Side effects:|| || Extremely Severe Side Effects|
|Condition / reason:|| || for tramflap surgery,implant removal|
|Dosage & duration:|| || not sure, administered by doctor (dosage frequency: only during surgery) for the period of not sure|
|Other conditions:|| || none|
|Other drugs taken:|| || none|
|Benefits:|| || none |
|Side effects:|| || I went into shock during recovery from surgery and was told I had allergic reaction to the morphine and not to ever take it again. I saw red spiders and hallucinated for weeks afterwards.|
|Comments:|| || Not sure of any details, since it was during surgery and I was not awake.|
Page last updated: 2017-01-13