What is morphine used for?

• Primarily, morphine is used to relieve severe pain, for example following surgery or a severe injury, or pain associated with cancer or a heart attack. It may also be used for other types of long-term (chronic) pain, when weaker painkillers no longer work.
• Morphine has other uses in terminal illness, for example it may be used to reduce coughing in lung cancer, when the coughing serves no purpose and can become painful and frustrating. It may also be used to reduce breathlessness at rest and so make people more comfortable in palliative care.

How does morphine work?

• Morphine sulphate is a strong painkiller. It is a type of medicine known as an opioid analgesic or opiate. Opioid analgesics work by mimicking the action of natural pain-reducing compounds called endorphins, which are produced in the brain and spinal cord.
• Morphine acts on the same opioid receptors as our natural endorphins. It stops pain signals being sent by the nerves to the brain. This means that even though the cause of the pain may remain, less pain is actually felt.
• Morphine reduces coughing by reducing the nerve signals sent from a part of the brain called the coughing centre to the muscles that produce coughing. This blocks the cough reflex.

Is morphine addictive?

• Yes, opioids are addictive when used recreationally. But in reality, if you're taking morphine to relieve pain it's highly unlikely that you will get addicted to it in the psychological sense, because you're not taking it to get a 'high'.
• If you need to take morphine for long periods of time your body can become tolerant to it, so it may get less effective and you may then need higher doses to control pain. With prolonged use it is possible to become dependent on morphine. However, this is not usually a problem when you stop taking it, because withdrawal symptoms can be avoided by gradually reducing the dose of morphine.
• It's important that you don't take a higher dose of morphine than prescribed by your doctor, or take it for longer than they recommend. When stopping treatment always follow your doctor's instructions.

Can I drink alcohol with morphine?

• Don't drink alcohol while taking morphine, as this will make you more likely to get side effects like drowsiness, dizziness, confusion and blurred vision. It may also increase the risk of serious side effects such as shallow breathing with a risk of stopping breathing, and loss of consciousness.

Can I drive while taking morphine?

• It may be an offence to drive while you are taking morphine. Do not drive if you think it affects your ability to drive safely, for example if it makes you feel sleepy, dizzy, unable to concentrate or make decisions, or if you have blurred or double vision.
• If you are driving dangerously while taking morphine you will be breaking the law. If you feel you are safe to drive while taking morphine, it's sensible to carry your prescription with you in case you are asked to take a saliva test by the police. If you test positive for morphine there is a medical defence if you are taking it as prescribed, as long as your driving is not impaired.

How is morphine given?

• In hospital morphine is often given by injection (sometimes in a morphine pump or morphine driver that you control yourself). It may also be given by suppository.
• Morphine can also be taken by mouth and there are several forms available. Fast-acting forms such as liquid morphine (eg Oramorph) and Sevredol tablets work quickly and may be prescribed to take as needed, or on a regular basis. Always follow your doctor's instructions.
• Slow-release forms are designed to release morphine continuously over either 12 or 24 hours to provide steady blood levels throughout the day and prolonged pain relief. These are suitable for controlling chronic pain and come under various brand names, including those below.

Brands of morphine that should be taken twice a day at 12 hourly intervals, for example 8am and 8pm:

• MST continus slow-release tablets.

Brands of morphine that should be taken once a day, at the same time each day (every 24 hours):

• MXL slow-release capsules.

If you take a slow-release form of morphine on a regular basis you may also be prescribed fast-acting morphine to take for breakthrough pain (if your pain comes back before your next dose is due). If you get a lot of breakthrough pain, keep a note of how much fast-acting morphine you need to use and tell your doctor. Your regular dose of slow-release morphine can then be increased by the right amount to keep you pain free.

How do I take morphine by mouth?

• It's important to follow the instructions given by your doctor regarding how often to take your morphine and for how long. This will depend on your level of pain and what form of morphine you have been given.
• All forms of morphine can be taken either with or without food.
• If you've been prescribed slow-release morphine tablets or capsules these must be swallowed whole with a drink. Don't break, crush, chew or suck these dose forms, as this will cause the whole dose to be rapidly absorbed into your body, which could cause a potentially fatal overdose.
• If you have trouble swallowing tablets or capsules tell your doctor. Some slow-release capsules can be opened and the granules inside sprinkled onto soft, cold food that can be easily swallowed without chewing, eg yoghurt.

What should I do if I forget to take a dose of morphine?

• This depends on the form of morphine you're taking and how late you are taking the dose. You should read the leaflet provided with your medicine to find out what to do, or call your doctor or pharmacist for advice.
• Never take a double dose of morphine to make up for a missed dose.

What if I take too much morphine?

• Morphine has severe and potentially fatal side effects in an overdose. Do not exceed the dose prescribed by your doctor.
• If you accidentally take too much morphine, or if you become very sleepy or have slow and/or shallow breathing after taking it, you or your carer should contact your doctor immediately or call for emergency help.

Common morphine side effects

• Feeling drowsy, sleepy or dizzy. Do not drive if affected.
• Feeling confused or disorientated. Again, do not drive if affected.
• Feeling sick or vomiting.
• Constipation. This can often be eased by eating plenty of fibre, such as fruit, green leafy vegetables and bran and by drinking six to eight glasses of water each day. However, if this doesn't work or isn't possible you might need a laxative. Ask your doctor for advice if you get constipated while taking morphine.
• Finding it difficult to pass urine.
• Dry mouth.
• Itching, sweating, flushing or rashes.
• Mood changes, which may include feeling happy or feeling uneasy.
• Hallucinations (seeing or hearing things that aren't really there).
• Problems with your vision, such as blurred or double vision. Don't drive if affected.
• Disturbed sleep.
• Headache.
• Loss of appetite.
• Indigestion or abdominal pain.
• Slow, shallow breathing.
• Pinpoint pupils.
• Low blood pressure.
• Rigid or twitching muscles.
• Awareness of your heartbeat (palpitations).

If you accidentally take too much morphine, or if you become very sleepy or have very slow and/or shallow breathing after taking it, you or your carer should contact your doctor immediately and call for emergency help.

Can I take other painkillers with morphine?

• It's fine to take non-prescription painkillers like paracetamol, ibuprofen and aspirin with morphine. These are weaker painkillers, but work in a different way to morphine so can be used alongside it. There's no point in taking other opioids like codeine or co-codamol with morphine though, since they work in the same way and can also have similar side effects.

But, if you find you're still getting pain despite taking morphine you should talk to your doctor, who may either increase your morphine dose or try you on a different painkiller.

Can I take morphine with other medicines?

• It's important to tell your doctor or pharmacist if you're already taking any medicines, including those bought without a prescription and herbal medicines, before you start treatment with morphine. Similarly, check with your doctor or pharmacist before taking any new medicines with morphine, to make sure that the combination is safe.

You're more likely to get side effects such as drowsiness, sedation, low blood pressure or slow, shallow breathing, if you take other medicines that have a sedative effect on the central nervous system with your morphine, for example:

• antihistamines that cause drowsiness, eg chlorphenamine, hydroxyzine
• antipsychotics, eg haloperidol, risperidone, olanzapine
• barbiturates, eg phenobarbital, amobarbital
• benzodiazepines, eg diazepam, temazepam
• muscle relaxants, eg baclofen
• other opioid painkillers, eg codeine, tramadol, oxycodone, fentanyl
• pregabalin
• sleeping tablets, eg zopiclone
• tricyclic antidepressants, eg amitriptyline.

Morphine may oppose the effects of the following medicines on the gut:

• domperidone
• metoclopramide.
• Morphine may increase the blood level of gabapentin.

The following medicines may reduce the amount of morphine in the blood and could make it less effective at relieving pain:

• rifampicin
• ritonavir.

References:

https://forum.alzheimers.org.uk/threads/oramorph-and-reason-for-pain.28698/

https://www.netdoctor.co.uk/medicines/aches-pains/a27008/morphine-with-other-medicines/

https://www.netdoctor.co.uk/medicines/aches-pains/a26990/morphine-sulphate-oramorph-mstcontinus-morphgesic-sevredol-mxl-zomorph/

http://painsupport.co.uk/forums/topic/26960/page/2/

https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/taste-changes

https://www.mayoclinic.org/drugs-supplements/morphine-oral-route/description/drg-20074216