Name of the medicine:

Morphine sulfate Modified Release (MR) – the ONLY modified release preparation of Morphine Sulfate that can be taken via enteral feeding tubes is named Zomorph®

The information given in this leaflet should be read along with any patient information leaflet provided by the manufacturer with your medicine. Click Search Results - (emc) (medicines.org.uk)

What is it for?

Morphine belongs to the group of medicines known as strong opioids. They are used to help manage pain, breathlessness or cough.

Most medicines available in the UK have a licence. The licence describes the conditions the medicine can be used to treat, and how the medicine can be given. The manufacturer of the medicine has to show that the medicine is safe and made to a high standard before the medicine is licenced.

The use of morphine for breathlessness and cough is outside its licence. Medicines used in palliative care are quite often used in this way. There is experience and research to support the use of morphine in this way. The person who prescribed your medicine will have carefully considered the benefits for you.

The information in this leaflet is not included in the information leaflet supplied with the medicine.

We are giving you this extra leaflet to tell you about the reason(s) why you are taking this medicine and to highlight other information. You should read both leaflets.  

What form(s) of this medicine are there and how is it usually taken?

Your morphine will be in capsules known as Zomorph®. These are a modified-release (MR) or long-acting forms of morphine. MR medication is released slowly into your body to provide relief from pain, breathlessness or cough throughout the day and night. Each dose lasts for around twelve hours. MR morphine should be taken in the morning and 12 hours later in the evening to keep a stable level of medicine in your body.

If you cannot swallow the capsule whole, you can take this medicine by opening the capsule and adding the contents to semi-solid food (e.g puree, jam, yoghurt). Do not chew or crush the capsule.

Alternatively, if you are unable to take the contents of the capsule, it can be administered into your stomach through a gastric or gastrostomy tube. This involves using a plastic mixing pot, water and a syringe. Place the contents of the capsule into the water and mix. The type of syringe you will be given is designed to fit into the connections to your feeding or enteral tube.  Having drawn up the solution administer it via the tube and then flush the tube with 30 ml to 50 ml of water.

What are the most common side effects I might experience?

You should contact your doctor or nurse if side effects become troublesome. Some of the side effects you may experience while you are taking morphine include:

·       Sleepiness: This may happen when you first start to take morphine or when the dose is increased. It should improve after a while.

·       Driving: You MUST NOT drive if you feel sleepy after taking your medicine

https://www.nhsinform.scot/care-support-and-rights/palliative-care/practical-help-and-advice/driving-when-taking-strong-painkillers

·       Dry mouth: Try to keep your mouth and lips clean and moist. If your mouth becomes sore, please see your healthcare professional for advice and help.

·       Sickness: If you feel sick when you first start to take morphine, your prescriber may need to give you some anti-sickness medicine until the sickness goes away.

·       Constipation: This is a common side effect of morphine. Your health professional will be able to prescribe a medicine to help you go to the toilet (laxative). It is also important to drink plenty of fluids.

What other information should I know about this medicine?

Please remember to order your repeat prescription with a few days spare, to allow it to be processed.

It is important not to order more medication than you need. Even if you return them to the pharmacy in future, they cannot be reused after they have been labelled for your use and must be disposed of.

Your medication needs to be kept in a safe place out of the reach of children.

It is important to store your medication in the original container.

Return ALL unused medication to a pharmacy.

If for any reason a you or your carer are UNABLE to go to the pharmacy, medication can be disposed of at home. However, it is important NOT to flush it down the toilet as this pollutes the water. Medication can be disposed of in a general waste bin, ensuring that cannot be accessed by children or animals, although disposal at a pharmacy is preferable.

Frequently asked questions

What do I do if I forget to take a regular dose of long-acting morphine?

Take a dose as soon as you remember. Do not take a double dose to make up for the missed one.

Will morphine always relieve my pain, breathlessness or cough completely?

Morphine is very good at helping to relieve pain, breathlessness or cough. It may not be effective for some of the causes of your symptoms. Other treatments may also be recommended by your health professional.

Will I become addicted to strong opioids and be unable to stop taking them?

No, this is very unlikely. You may be aware that strong opioids are also used as a substitute medication for people with drug addiction.  You have not been prescribed a strong opioid for this reason. You have been prescribed a strong opioid for relief of your pain, breathlessness or cough.

How will I know what problems to look for if the morphine is not working so well for my symptoms?

You may still experience symptoms even if your health professional has increased the dose of morphine you take. You may feel unwell in one or more of these ways:

·       more sleepy than usual

·       feeling sick more of the time

·       restlessness or jumpiness in your arms or legs

·       bad dreams

·       confusion

·       shadows in the corner of your vision or hallucinations.

Do not worry if this happens and do not stop taking your morphine suddenly. Tell a member of the team looking after you the day these symptoms occur, so they can advise on what to do next.

Can morphine interfere with my other medicines?

Remind your health professional what other medicines you are taking so that they can adjust your other medicines if needed.

Can I drink alcohol?

It is best to avoid alcohol as it may make you feel very sleepy when taken with morphine.