Morphine Forte: Uses, Side Effects and Dosage

Serious Warnings and Precautions

What is Morphine Forte and Morphine Extra-Forte used for?

Morphine Forte and Morphine Extra-Forte are injections containing morphine sulfate (an opioid analgesic) used to control severe pain in patients who need an opioid administered by injection.

How does Morphine Forte and Morphine Extra-Forte work?

Morphine Forte and Morphine Extra-Forte are painkillers belonging to the class of drugs known as opioids. It relieves pain by acting on specific nerve cells of the spinal cord and brain.

What are the ingredients in Morphine Forte and Morphine Extra-Forte?

Medicinal ingredient: Morphine Sulfate

Non-medicinal ingredients: Water for injection

Morphine Forte and Morphine Extra-Forte comes in the following dosage forms:

Solution for injection of 25 mg/mL and 50 mg/mL

Do not use Morphine Forte and Morphine Extra-Forte if:

• your doctor did not prescribe them for you
• you are allergic to morphine sulfate or any of the other ingredients in Morphine Forte and Morphine Extra-Forte you can control your pain by the occasional use of other pain medications. This includes those available without a prescription
• you have severe asthma, trouble breathing, or other breathing problems
• you have any heart problems
• you have bowel blockage or narrowing of the stomach or intestines
• you have severe pain in your abdomen
• you have a head injury
• you are at risk for seizures

• you suffer from alcoholism

• you are taking or have taken within the past 2 weeks a Monoamine Oxidase inhibitor (MAOi) (such as phenelzine sulphate, tranylcypromine sulphate, moclobemide or selegiline)
• you are going to have, or recently had, a planned surgery

To help avoid side effects and ensure proper use, talk to your healthcare professional before you take Morphine Forte and Morphine Extra-Forte. Talk about any health conditions or problems you may have, including if you:

• have a history of illicit or prescription drug or alcohol abuse
• have severe kidney, liver or lung disease
• have heart disease
• have low blood pressure
• have past or current depression
• suffer from chronic or severe constipation
• have problems with your thyroid, adrenal or prostate gland
• have, or had in the past hallucinations or other severe mental problems
• suffer from migraines
• are planning to become pregnant

Other warnings you should know about:

Opioid dependence and addiction: There are important differences between physical dependence and addiction. It is important that you talk to your doctor if you have questions or concerns about abuse, addiction or physical dependence.

Pregnancy, nursing, labour and delivery: Opioids can be transferred to your baby through breast milk, or while still in the womb. Morphine Forte and Morphine Extra-Forte can then cause life-threatening breathing problems in your unborn baby or nursing infant. Your doctor will determine if the benefits of using Morphine Forte or Morphine Extra-Forte outweigh the risks to your unborn baby or nursing infant.

If you are pregnant and are taking Morphine Forte or Morphine Extra-Forte, it is important that you don’t stop taking your medication all of a sudden. If you do, it can cause a miscarriage or a still-birth. Your doctor will monitor and guide you on how to slowly stop taking Morphine Forte or Morphine Extra-Forte. This may help avoid serious harm to your unborn baby.

Driving and using machines: Before you do tasks which may require special attention, you should wait until you know how you react to Morphine Forte and Morphine Extra-Forte. Morphine Forte and Morphine Extra-Forte can cause:

• drowsiness
• dizziness or
• lightheadedness

This can usually occur after you take your first dose and when your dose is increased.

Disorder of the adrenal gland: You may develop a disorder of the adrenal gland called adrenal insufficiency. This means that your adrenal gland is not making enough of certain hormones. You may experience symptoms such as:

• nausea, vomiting
• feeling tired, weak or dizzy
• decreased appetite

You may be more likely to have problems with your adrenal gland if you have been taking opioids for longer than one month. Your doctor may do tests, give you another medication, and slowly take you off Morphine Forte and Morphine Extra-Forte.

Serotonin Syndrome: Morphine Forte and Morphine Extra-Forte can cause Serotonin Syndrome, a rare but potentially life-threatening condition. It can cause serious changes in how your brain, muscles and digestive system work. You may develop Serotonin Syndrome if you take Morphine Forte and Morphine Extra-Forte with certain anti-depressants or migraine medications.

Serotonin Syndrome symptoms include:

• fever, sweating, shivering, diarrhea, nausea, vomiting;
• muscle shakes, jerks, twitches or stiffness, overactive reflexes, loss of coordination;
• fast heartbeat, changes in blood pressure;
• confusion, agitation, restlessness, hallucinations, mood changes, unconsciousness, and coma.

Sexual Function/Reproduction: Long term use of opioids may lead to a decrease in sex hormone levels. It may also lead to low libido (desire to have sex), erectile dysfunction or being infertile.

Tell your healthcare professional about all the medicines you take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

The following may interact with Morphine Forte and Morphine Extra-Forte:

• Alcohol. This includes prescription and non-prescription medications that contain alcohol. Do not drink alcohol while you are taking Morphine Forte and Morphine Extra-Forte. It can lead to:

  • drowsiness
  • unusually slow or weak breathing
  • serious side effects or
  • a fatal overdose
• other sedative drugs which may enhance the drowsiness caused by Morphine Forte and Morphine Extra-Forte
• other opioid analgesics (drugs used to treat pain)
• general anesthetics (drugs used during surgery)
• benzodiazepines (drugs used to help you sleep or that help reduce anxiety)
• antidepressants (for depression and mood disorders). Do not take Morphine Forte nor Morphine Extra-Forte with MAO inhibitors (MAOi) or if you have taken MAOi’s in the last 14 days.
• drugs used to treat serious mental or emotional disorders (such as schizophrenia)
• antihistamines (drugs used to treat allergies)
• anti-emetics (drugs used for the prevention of vomiting)
• drugs used to treat muscle spasms and back pain
• drugs used to treat migraines (e.g. triptans)
• St. John’s Wort

How to take Morphine Forte and Morphine Extra-Forte:

Morphine Forte and Morphine Extra-Forte, used without dilution are indicated for the relief of severe pain in narcotic-tolerant patients and therefore are not to be given to patients who are not already receiving large doses of narcotics.

Morphine Forte and Morphine Extra-Forte are given under the skin, into the muscle or vein in doses or concentrations that are higher than those usually needed.

The initial dosage should be based on the preceding (or previous) morphine or other narcotic regimen used by the patient.

Usual Adult Starting Dose:

Your dose is tailored/personalized just for you.

Your doctor will prescribe the lowest dose that works to control your pain. It is recommended that you only take Morphine Forte and Morphine Extra-Forte for up to 7 days. If you need to take Morphine Forte and Morphine Extra-Forte for longer, your doctor will determine the best dose for you to lower the risk of side effects and overdose. Higher doses can lead to more side effects and a greater chance of overdose.

Review your pain regularly with your doctor to determine if you still need Morphine Forte and Morphine Extra-Forte. Be sure to use Morphine Forte and Morphine Extra-Forte only for the condition for which it was prescribed.

If your pain increases or you develop any side effect as a result of taking Morphine Forte and Morphine Extra-Forte, tell your doctor immediately.

Stopping your Medication

If you have been taking Morphine Forte and Morphine Extra-Forte for more than a few days you should not stop taking it all of a sudden. Your doctor will monitor and guide you on how to slowly stop taking Morphine Forte and Morphine Extra-Forte. You should do it slowly to avoid uncomfortable symptoms such as having:

• body aches
• diarrhea
• goosebumps
• loss of appetite
• nausea
• feeling nervous or restless
• runny nose
• sneezing
• tremors or shivering
• stomach cramps
• rapid heart rate (tachycardia)
• having trouble sleeping
• an unusual increase in sweating
• heart palpitations
• an unexplained fever
• weakness
• yawning

By reducing or stopping your opioid treatment, your body will become less used to opioids. If you start treatment again, you will need to start at the lowest dose. You may overdose if you restart at the last dose you took before you slowly stopped taking Morphine Forte or Morphine Extra-Forte.

Refilling your Prescription for Morphine Forte and Morphine Extra-Forte:

A new written prescription is required from your doctor each time you need more Morphine Forte and Morphine Extra-Forte.

Only obtain prescriptions for this medicine from the doctor in charge of your treatment. Do not seek prescriptions from other doctors unless you switch to another doctor for your pain management.

Overdose:

Signs of overdose may include:

• unusually slow or weak breathing
• dizziness
• confusion
• extreme drowsiness

What are possible side effects from using Morphine Forte and Morphine Extra-Forte?

These are not all the possible side effects you may feel when taking Morphine Forte and Morphine Extra-Forte. If you experience any side effects not listed here, contact your healthcare professional.

Side effects may include:

• Drowsiness
• Insomnia
• Dizziness
• Fainting
• Nausea, vomiting, or a poor appetite
• Dry mouth
• Headache
• Problems with vision
• Weakness, uncoordinated muscle movement
• Itching
• Sweating
• Constipation
• Low sex drive, impotence (erectile dysfunction), infertility

Talk with your doctor or pharmacist about ways to prevent constipation when you start using Morphine Forte and Morphine Extra-Forte.

Serious side effects and what to do about them

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, talk to your healthcare professional.

Reporting Side Effects

Storage:

• Keep unused or expired Morphine Forte and Morphine Extra-Forte in a secure place to prevent theft, misuse or accidental exposure.
• Store at controlled room temperature (15°C to 30°C). Protect from light and freezing.
• Keep Morphine Forte and Morphine Extra-Forte under lock, out of sight and reach of children and pets.
• Never take medicine in front of small children as they will want to copy you. Accidental ingestion by a child is dangerous and may result in death. If a child accidentally takes Morphine Forte or Morphine Extra-Forte, get emergency help right away.

If you want more information about Morphine Forte and Morphine Extra-Forte:

• Talk to your healthcare professional
• Find the full product monograph that is prepared for healthcare professionals and includes this consumer medication information by visiting the Health Canada website (https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html); or by calling 1-800-463-6001.

Pfizer Canada Inc.

Kirkland, Québec H9J 2M5

Last Revised: August 6, 2018