A1,
A2,
B,
C1,
C2,
D,
E,
F,
G-H,
I-K,
L,
M,
N,
O,
P1,
P2,
Q-R,
S,
T,
U-V,
W-Z
MS-Contin Side Effects, and Drug Interactions - Morphine
MS-Contin Side Effects, and Drug Interactions - Morphine
SIDE EFFECTS
Adverse reactions caused by morphine
are essentially those observed with other opioid
analgesics. They include the following major hazards: respiratory
depression, and less frequently, circulatory depression,
apnea, shock and
cardiac arrest
secondary to respiratory
and/or circulatory depression.
Most Frequently Observed Reactions
Constipation, nausea, vomiting, lightheadedness, dizziness,
sedation, dysphoria,
euphoria, and sweating.
Some of these effects seem to be more prominent in ambulatory patients
and in those not experiencing severe pain. Some adverse reactions
in ambulatory patients may be alleviated if the patient
is in a supine position.
Less Frequently Observed REACTIONS
Body as a Whole: Edema, antidiuretic
effect, chills, muscle
tremor, muscle rigidity.
Cardiovascular: Flushing of the face, tachycardia,
bradycardia, palpitation, faintness, syncope,
hypotension, hypertension.
Gastrointestinal: Dr.
mouth, biliary
tract spasm,
laryngospasm, anorexia, diarrhea,
cramps, taste alterations.
Genitourinary: Urine retention
or hesitance, reduced libido
and/or potency.
Nervous System: Weakness, headache,
agitation, tremor,
uncoordinated muscle movements, seizure,
paresthesia, alterations
of mood (nervousness, apprehension,
depression, floating
feelings), dreams, transient
hallucination and disorientation, visual
disturbances, insomnia,
increased intracranial pressure.
Skin: Pruritus, urticaria
and other skin rashes.
Special Senses: Blurred vision, nystagmus,
diplopia, miosis.
DRUG ABUSE AND DEPENDENCE
Opioid analgesics may cause
psychological
and physical dependence
(see WARNINGS). Physical dependence
results in withdrawal
symptoms in patients who abruptly discontinue the drug,
or these symptoms may be precipitated through the administration
of drugs with antagonistic activity, e.g., naloxone or mixed
agonist/antagonist analgesics (pentazocine, etc.; see also OVERDOSAGE).
Physical dependence
usually does not occur, to a clinically significant degree, until
several weeks of continued opioid
usage. Tolerance, in which increasingly larger doses are required
to produce the same degree
of analgesia, is initially manifested by a shortened duration
of analgesic effect
and, subsequently, by decreases in the intensity
of analgesia. In patients
with chronic pain, as well
as in opioid-tolerant cancer
patients, the administration of ORAMORPH SR
(morphine sulfate) should be guided by the degree
of tolerance manifested. Physical dependence,
per se, is not ordinarily a concern when one is dealing with
opioid-tolerant patients whose pain
and suffering is associated with an irreversible
illness.
If ORAMORPH SR is abruptly
discontinued, an abstinence
syndrome may occur.
Withdrawal symptoms, in patients dependent on morphine, begin shortly
before the time of the
next scheduled dose, reaching a peak at 36 to 72 hours after the
last dose, and then slowly subside over a period
of 7 to 10 days. Symptoms include yawning, sweating, lacrimation,
rhinorrhea, restless
sleep, dilated pupils, gooseflesh, irritability, tremor,
nausea, vomiting, and
diarrhea.
Treatment of the abstinence
syndrome is primarily
symptomatic and
supportive, including maintenance of proper fluid
and electrolyte
balance. If withdrawal has inadvertently been precipitated in a
patient who requires
narcotics for pain management,
the withdrawal syndrome
can be terminated rapidly by the administration
of an appropriate
dose of a proof
agonist opioid, such
as morphine. The degree
of physical dependence
of a patient on ORAMORPH
SR can be intentionally reduced by a gradual reduction
of dosage and symptomatic
treatment of withdrawal
symptomatology.
DRUG INTERACTIONS
Use with Other Central Nervous System Depressants: The
depressant effects of morphine
are potentiated by the presence of other CNS
depressants such as alcohol,
sedatives, antihistaminics, or psychotropic drugs. Use of neuroleptics
in conjunction with oral
morphine may increase
the risk of respiratory
depression, hypotension
and profound sedation
or coma.
Interaction with Mixed Agonist/Antagonist Opioid Analgesics:
Agonist/antagonist analgesics (i.e., pentazocine, nalbuphine, butorphanol,
or buprenorphine) should NOT be administered to patients who have
received or are receiving a course of therapy
with a proof opioid
agonist analgesic. In
these patients, the mixed
agonist/antagonist may alter the analgesic effect or may precipitate
withdrawal symptoms.
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