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Other strengths and forms by Unimed Unihealth Pharmaceuticals Ltd.
Indications & Uses
Morphine Sulfate Sulphate is used for long-term relief of severe pain that doesn't respond to other treatment, and for relief of pain after an operation.
Pharmacology
Morphine is a phenanthrene derivative that works mainly on the CNS and on smooth muscles. It binds to opiate receptors in the CNS and changes how pain is perceived and how the body responds to it. Analgesia, euphoria and dependence are thought to come from its action at the mu-1 receptors. Respiratory depression and slowing of intestinal movements are thought to come from its action at the mu-2 receptors. Spinal analgesia happens through the agonist action of morphine at the K receptor.
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
15 mg retard tablet. Adults: a patient with severe pain that weaker opioids (for example dihydrocodeine) have not controlled should normally start on 30 mg every 12 hours. Patients who were on normal release oral morphine should get the same total daily dose as Morphine Sulphate 15 mg tablets, but divided into doses 12 hours apart. As the pain gets worse, the tablet dose will need to go up. Where possible, higher doses should be made in increments of 30 to 50% as required. The right dose for any one patient is the one that controls pain for a full 12 hours with no side effects, or side effects the patient can tolerate. Patients moving from parenteral morphine to Morphine Sulphate 15 mg tablets need a sufficiently increased dose to make up for the weaker analgesic effect of oral use. This increase is usually of the order of 100%, and the dose has to be adjusted for each patient. Children: for severe cancer pain, a starting dose in the range of 0.2 to 0.8 mg morphine per kg bodyweight every 12 hours is recommended. Post-operative pain: Morphine Sulphate 15 mg tablets are not recommended in the first 24 hours after surgery, or until normal bowel function has returned. After that, the following schedule is suggested, at the physician's discretion: (a) Morphine Sulphate 30 mg tablets every 12 hours for patients over 70 kg, (c) Elderly, a lower dose may be advisable, (d) Children, not recommended. Supplemental parenteral morphine can be given if needed, but the total morphine dose must be watched carefully, and the prolonged effect of this prolonged release formulation should be kept in mind.
10 mg tablet. Adults and children over 12 years: the dose of Morphine 10 mg tablet depends on how severe the pain is and what analgesics the patient has needed before. One tablet is taken every four hours, or as the physician directs. If the pain becomes more severe, or the patient develops tolerance to morphine, a higher dose of Morphine 10 mg tablet will be needed for the desired relief. Patients taking morphine orally in place of parenteral morphine need a sufficiently increased dose to make up for the weaker analgesic effect of oral use. This increase is usually of the order of 100%, and the dose has to be adjusted for each patient. Elderly: a lower dose than the adult dose may be advisable. Children 3 to 12 years: 3 to 5 years, 5 mg every 4 hours; 6 to 12 years, 5 to 10 mg every 4 hours.
Oral Solution. Adults: the usual dose is 10 to 20 mg (5 to 10 ml) every 4 hours. Children 13 to 18 years: maximum single dose 5 to 20 mg (2.5 to 10 ml) every 4 hours. Children 6 to 12 years: maximum dose 5 to 10 mg (2.5 to 5 ml) every 4 hours. Children 1 to 5 years: maximum dose 5 mg (2.5 ml) every 4 hours. Children under 1 year: not recommended. The dose can be increased under medical supervision, depending on the severity of the pain and the patient's previous analgesic needs. A lower dose may be appropriate in the elderly, in patients with moderate to severe renal or hepatic impairment, or where sedation is undesirable.
Morphine Sulfate is readily absorbed from the gastrointestinal tract after oral use. Even so, when the Oral Solution (5 mg/5 ml) is used in place of parenteral morphine, a 50% to 100% increase in dose is usually required to get the same level of analgesia.
Side Effects
In normal doses, the commonest side effects of morphine are nausea, vomiting, constipation and drowsiness. With long-term treatment, nausea and vomiting are unusual with morphine sulphate tablets, but if they do occur, the tablets can easily be combined with an anti-emetic when needed. Constipation may be treated with suitable laxatives. Psychiatric disorders: confusion and insomnia are common. Nervous system disorders: dizziness, headache, involuntary muscle contractions and somnolence are common. Gastrointestinal disorders: constipation and nausea are very common, while abdominal pain, anorexia, dry mouth and vomiting are common. Skin and subcutaneous tissue disorders: hyperhidrosis and rash are common. General disorders: asthenic conditions and pruritus.
Cautions & Contraindications
Warnings & Precautions
The main risk of taking too much of an opioid is respiratory depression. As with all narcotics, a lower dose may be advisable in the elderly, and in people with hypothyroidism, renal disease or chronic hepatic disease. Use Morphine Sulfate with caution in patients with impaired respiratory function, severe bronchial asthma, convulsive disorders, acute alcoholism, delirium tremens, raised intracranial pressure, hypotension with hypovolaemia, severe cor pulmonale, opioid dependence, a history of substance abuse, diseases of the biliary tract, pancreatitis, inflammatory bowel disorders, prostatic hypertrophy or adrenocortical insufficiency. Morphine Sulfate Sulphate tablets should not be used where paralytic ileus could occur. If paralytic ileus is suspected, or happens during use, stop the Morphine Sulfate Sulphate tablets immediately. Morphine Sulfate may lower the seizure threshold in patients with a history of epilepsy. People with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. With long-term use, a patient may develop tolerance and need higher and higher doses to keep pain under control. Prolonged use of Morphine Sulfate may lead to physical dependence, and a withdrawal syndrome may occur if the treatment is stopped suddenly. When a patient no longer needs morphine, it may be advisable to lower the dose gradually to prevent withdrawal symptoms. Very rarely, especially at high doses, hyperalgesia may occur that does not respond to a further increase in the dose of morphine Sulphate. A dose reduction of morphine Sulphate, or a change to another opioid, may then be needed. Morphine Sulfate has an abuse profile similar to other strong agonist opioids. People with a latent or manifest addiction disorder may seek it out and abuse it. There is a chance of psychological dependence (addiction) with opioid analgesics, morphine included. Use the medicine with particular care in patients with a history of alcohol and drug abuse. If the oral forms are abused by injection, serious adverse events can be expected, and these may be fatal.
Contraindications
Morphine Sulphate should not be given to anyone with a known hypersensitivity. This includes known sensitivity to morphine itself. It is also contraindicated in respiratory depression, head injury, obstructive airways disease, paralytic ileus, acute abdominal pain, delayed gastric emptying and acute hepatic disease. People taking mono-amine oxidase inhibitors, or who stopped them within the last two weeks, must not use it either. Morphine Sulphate is not recommended during pregnancy, and it is not recommended for children below 3 years of age.
Pregnancy & Breastfeeding
Morphine Sulphate is not recommended during pregnancy or labour, because it can cause respiratory depression in the newborn. Nursing mothers should not be given it either, as morphine passes into breast milk. If a mother has been on long-term treatment, her new born baby may show withdrawal symptoms.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Overdose
Morphine toxicity and overdose show up as pin-point pupils, floppy skeletal muscles, a slow heart rate, slowed breathing, low blood pressure, drowsiness and depression of the central nervous system. This can progress to stupor or coma. In more severe cases the circulation may fail and the coma may deepen, and overdose can lead to death. Rhabdomyolysis progressing to renal failure has also been reported in opioid overdose.
The first priority is to establish a clear airway and to start assisted or controlled ventilation. Oral activated charcoal (50g for adults, 1g/kg for children) may be considered if a substantial amount has been taken within one hour, provided the airway can be protected. The pure opioid antagonists are specific antidotes against the effects of opioid overdose, and other supportive measures should be used as needed.
In massive overdose, give naloxone 0.8 mg intravenously. Repeat it at 2 to 3 minute intervals as necessary, or give an infusion of 2 mg in 500 ml of normal saline or 5% dextrose (0.004 mg/ml). The infusion rate should be based on the bolus doses already given and should follow the patient's response. Naloxone acts for a relatively short time, so the patient must be watched carefully until spontaneous breathing is reliably re-established.
For a less severe overdose, give naloxone 0.2 mg intravenously, followed by increments of 0.1 mg every 2 minutes if required.
Don't give naloxone unless there is clinically significant respiratory or circulatory depression caused by morphine overdose. Give it cautiously to people who are known or suspected to be physically dependent on morphine, because an abrupt or complete reversal of the opioid effects may bring on an acute withdrawal syndrome.
⚠️ In an emergency call 999 or go to the nearest hospital emergency department.
Storage
Keep Morphine Sulfate in a cool, dry place, away from light.
Drug Interactions
Common questions about MSL 10 mg
What is MSL 10 mg Tablet?
MSL 10 mg Tablet is a medicine that contains Morphine Sulfate. It is made by Unimed Unihealth Pharmaceuticals Ltd. It belongs to the Opioid analgesics group of medicines.
What is MSL used for?
Morphine Sulfate Sulphate is used for long-term relief of severe pain that doesn't respond to other treatment, and for relief of pain after an operation.
What are the side effects of MSL?
In normal doses, the commonest side effects of morphine are nausea, vomiting, constipation and drowsiness. With long-term treatment, nausea and vomiting are unusual with morphine sulphate tablets, but if they do occur, the tablets can easily be combined with an anti-emetic when needed.
Can I take MSL during pregnancy or while breastfeeding?
Morphine Sulphate is not recommended during pregnancy or labour, because it can cause respiratory depression in the newborn. Nursing mothers should not be given it either, as morphine passes into breast milk. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
What happens if I take too much MSL?
Morphine toxicity and overdose show up as pin-point pupils, floppy skeletal muscles, a slow heart rate, slowed breathing, low blood pressure, drowsiness and depression of the central nervous system. This can progress to stupor or coma. In an emergency call 999 or go to the nearest hospital emergency department.
How should I store MSL?
Keep Morphine Sulfate in a cool, dry place, away from light.
Can I take other medicines with MSL?
Some medicines can interact with Morphine Sulfate, for example: Nalbuphine Hydrochloride, Buprenorphine, Pentazocine, Rifampicin, Cimetidine, Ritonavir. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
MSL is already among the lowest-priced brands of Morphine Sulfate at this strength.
Do I need a prescription for MSL?
MSL is a prescription (Rx) medicine. Take it as your doctor advises.