DBL Morphine Tartrate Injection

Generic Name: morphine tartrate
Product Name: DBL Morphine Tartrate Injection

Indication: What DBL Morphine Tartrate Injection is used for

Morphine is used most commonly for the relief of severe pain. It may also be used just before or during an operation to help the anaesthetic work better.

Your doctor may have prescribed morphine for another reason. Ask your doctor if you have any questions about why morphine has been prescribed for you.

Morphine may produce physical dependency if used for a long time (i.e. more than two weeks). Physical dependency means you may experience unpleasant feelings if you stop morphine suddenly. However, it is also important to keep your pain under control. Your doctor can advise you on how to manage this.

This medicine is available only with a doctor’s prescription.

Action: How DBL Morphine Tartrate Injection works

Morphine is a pain reliever that belongs to a group of medicines called opioid analgesics. Morphine acts in the brain and spinal cord.

Morphine, the principal alkaloid of opium, is an opioid analgesic. It has agonist activity, binding to receptors in the brain, spinal cord and other tissues. Morphine is most active at the mu receptors, but is also active at the kappa receptors and may have some agonist activity at the delta receptors. The mu receptors are widely distributed throughout the central nervous system, particularly in the limbic system, thalamus, striatum, hypothalamus and midbrain, and in the dorsal horn of the spinal cord. Kappa receptors are localised primarily in the cerebral cortex and spinal cord, while delta receptors occur in the limbic system.

Morphine exerts its primary effect on the central nervous system (CNS) and on organs containing smooth muscle, including the intestines.

Morphine produces many pharmacological effects including analgesia, decreased gastrointestinal motility, respiratory depression, cough suppression, drowsiness, miosis, mood changes including euphoria and dysphoria, reduction in body temperature, and alterations in both the endocrine system and autonomic nervous system.

Morphine tartrate has the same pharmacological activity as other morphine salts.

The active ingredient is morphine tartrate. The inactive ingredients are sodium metabisulphite and water for injections.

DBL Morphine Tartrate Injection does not contain lactose, sucrose, gluten, tartrazine or any other azo dyes.

Dose advice: How to use DBL Morphine Tartrate Injection

Before you are given Morphine Injection

When you must not be given it

You should not be given morphine if you have an allergy to morphine or any of the ingredients listed here. Symptoms of an allergic reaction to morphine may include:

• Shortness of breath, wheezing or difficulty breathing;
• Swelling of the face, lips, tongue or other parts of the body;
• Rash, itching or hives on the skin.

You should not be given morphine if:

• You have severe bronchial asthma or any other lung or breathing problems;
• You are suffering from acute alcoholism;
• You are undergoing treatment with monoamine oxidase (MAO) inhibitors (e.g. phenelzine, tranylcypromine, moclobemide or selegeline), or have stopped MAO inhibitor treatment during the last fourteen days;
• You have an irregular heartbeat (arrhythmia);
• You have severe liver problems;
• You have a head injury, brain tumour or increased pressure in the head.

Morphine Injection must not be given to premature infants or during labour for delivery of premature infants.

Do not use Morphine Injection after the expiry date (EXP) printed on the pack. If you are given this medicine after the expiry date has passed, it may not work as well. Do not use Morphine Injection if the packaging is torn or shows signs of tampering.

If you are not sure whether you should be given morphine, talk to your doctor or pharmacist.

Before you are given it

Tell your doctor or pharmacist if you have allergies to:

• Any other medicines;
• Any other substances, such as foods, preservatives or dyes.

Tell your doctor or pharmacist if you are pregnant or intend to become pregnant. Your doctor or pharmacist will discuss the possible risks and benefits of you being given morphine during pregnancy.

Tell your doctor or pharmacist if you are breastfeeding or plan to breastfeed. As morphine passes into breast milk, breastfeeding is not recommended while you are being given morphine.

Tell your doctor or pharmacist if you have or have had any medical conditions, especially the following:

• Epilepsy, convulsions, fits or seizures;
• Under-active thyroid gland (hypothyroidism) and/or adrenal gland (Addison’s disease);
• Enlarged prostate or problems with urination;
• Liver problems;
• Kidney problems;
• Any bowel disorders or ulcerative colitis;
• Biliary tract disease or inflammation of the pancreas;
• Myasthenia gravis.

If you have not told your doctor or pharmacist about any of the above, tell them before you are given Morphine Injection.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

Some medicines and morphine may interfere with each other. These include:

• Antidepressants which belong to the group of medicines called monoamine oxidase inhibitors i.e. moclobemide, phenelzine, tranylcypromine;
• Selegeline, a monoamine oxidase inhibitor used to treat Parkinson’s disease;
• Alcohol;
• Cimetidine (Tagamet, Magicul), a medicine used to treat stomach or duodenal ulcers, or reflux;
• Diuretics (fluid tablets);
• Other medicines which may make you drowsy such as sleeping tablets, tablets to calm your nerves, medicines to treat mental disorders, other strong painkillers, some antihistamines and some heart medication;
• Medicines that lower your blood pressure (antihypertensives);
• Warfarin (Marevan, Coumadin), a medicine used to thin the blood;
• Zidovudine (Retrovir, Combivir, Trizivir) a medicine used to treat HIV infection;
• Ritonavir (Kaletra, Norvir), a medicine used to treat HIV infection.

These medicines may be affected by morphine or may affect how well it works. You may need different amounts of your medicine, or you may need to take different medicines. Your doctor or pharmacist will advise you.

Your doctor and pharmacist may have more information on medicines to be careful with or avoid while receiving Morphine Injection.

How Morphine Injection is given

How much is given

Your doctor will decide what dose of morphine you will receive. This depends on your condition and other factors, such as your weight.

How it is given

Your doctor or nurse will usually give morphine to you.

Morphine can be given as:

• An injection into a muscle;
• A slow injection into a vein;
• An injection under the skin or;
• By a method called patient-controlled analgesia; this method allows you, the patient, to control the amount of morphine you wish to receive. On experiencing pain, you can press a button, which allows a dose of morphine to be administered to you. To prevent you receiving too much morphine, there is a “lockout” period built into the pump which prevents continuous injection of morphine.

Your doctor will decide the most appropriate way for you to be given morphine.

If you take too much (overdose)

If you have received too much morphine, you may have symptoms which include severe drowsiness, slow or troubled breathing, severe weakness, slow heartbeat, pale and cold skin.

Immediately telephone your doctor or the Poisons Information Centre (Australia on 131 126 or New Zealand on 0800 764 766) for advice, or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much Morphine. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

While you are being given Morphine Injection

Things you must do

Tell any other doctors, dentists, and pharmacists who are treating you that you are being given morphine.

If you are about to be started on any new medicine, tell your doctor, dentist or pharmacist that you are being given morphine.

If you plan to have surgery that needs a general anaesthetic, tell your doctor or dentist that you are being given morphine.

If you become pregnant while you are being treated with morphine, tell your doctor or pharmacist immediately.

Things you must not do

Do not give Morphine Injection to anyone else, even if they have the same condition as you.

Do not use Morphine Injection to treat any other complaints unless your doctor tells you to.

Do not stop using morphine, or lower the dosage, without checking with your doctor or pharmacist. If you have been using morphine for more than two weeks, you may experience unpleasant feelings if you stop morphine suddenly. Your doctor will probably want you to gradually reduce the amount of morphine you are using, before stopping it completely.

Do not take any other medicines, whether they are prescription or over-the-counter medicines, unless they have been approved or recommended by a doctor or pharmacist who knows you are being given morphine.

Things to be careful of

Be careful driving or operating machinery until you know how morphine affects you. Morphine may cause drowsiness, and impairment of coordination, in some people. Make sure you know how you react to morphine. Do not drive a car, operate machinery, or do anything else that could be dangerous if you are drowsy or feeling uncoordinated.

Do not drink alcohol, while you are undergoing treatment with morphine unless otherwise advised by your doctor or pharmacist, as drowsiness and coordination impairment may be worse.

As morphine may cause nausea and vomiting, your doctor is likely to prescribe medicine for you to take/receive before the morphine, to stop you feeling sick. Morphine may also cause constipation, so your doctor is likely to prescribe laxatives to prevent this happening.

Tell your doctor, pharmacist or nurse if you have any concerns about being given morphine.

Schedule of DBL Morphine Tartrate Injection

DBL Morphine Tartrate Injection is a Schedule 8 medicine.

Side effects of DBL Morphine Tartrate Injection

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are being given morphine. Morphine helps most people with severe pain, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

If you are over 65 years of age you may have an increased chance of getting side effects.

Ask your doctor or pharmacist to answer any questions you may have.

If you get any side effects, do not stop using morphine without first talking to your doctor or pharmacist.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

• Drowsiness, dizziness or unsteadiness;
• Light-headedness;
• Confusion;
• Sweating or flushing;
• Nausea and/or vomiting;
• Constipation;
• Pain and irritation at the injection site;
• Blurred vision;
• Dry mouth;
• Mood changes;
• Red, itchy skin.

These are the more common side effects of Morphine Injection. Mostly they are mild and short-lived.

If any of the following happen, tell your doctor or pharmacist immediately or go to the Accident and Emergency department at your nearest hospital:

• Any signs of an allergic reaction to morphine (which are listed here);
• Severe drowsiness;
• Slow or troubled breathing;
• Severe weakness;
• Agitation;
• Hallucinations;
• Seizures (fits);
• Unconsciousness;
• Slow or rapid heartbeat;
• Difficulty in urinating.

These are serious side effects. You may need urgent medical attention or hospitalisation.

Other side effects not listed above may occur in some patients. Tell your doctor or pharmacist if you notice anything that is making you feel unwell.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

For further information talk to your doctor.

References

1. DBL Morphine Tartrate Injection Consumer Medicine Information (CMI). Melbourne VIC: Hospira Australia Pty Ltd. September 2014. [PDF]
2. DBL Morphine Tartrate Injection Product Information (PI). Melbourne VIC: Hospira Australia Pty Ltd. December 2015. [PDF]