Morphine sulfate (mor-fean sul-fate)
Consumer Medicine Information
What is in this leaflet
This leaflet answers some common questions about MS Mono modified release capsules ("capsules").
It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.
All medicines have risks and benefits. Your doctor has weighed the risks of you taking this medicine against the benefits they expect it will have for you.
If you have any concerns about using this medicine, ask your doctor or pharmacist.
Keep this leaflet with the medicine.
You may need to read it again.
What MS Mono capsules are taken for
MS Mono capsules contain morphine sulfate. Morphine belongs to a group of medicines called opioid analgesics.
MS Mono capsules are used to treat chronic severe pain.
Ask your doctor if you have any questions about why it has been prescribed for you.
As with all strong painkillers, your body may become used to you taking MS Mono capsules. Taking it may result in physical dependence. Physical dependence means that you may experience withdrawal symptoms if you stop taking MS Mono capsules suddenly, so it is important to take it exactly as directed by your doctor.
This medicine is only available with a doctor's prescription.
Before you take it
When you must not take it
Do not take MS Mono capsules if you:
have any breathing problems such as acute asthma, respiratory depression (breathing slows or weakens) or other obstructive airways disease
are severely drowsy or have a reduced level of consciousness
suffer from irregular heartbeats or changes in the way the heart beats
have heart disease due to long-term lung disease
have just consumed a large amount of alcohol, regularly consume large amounts of alcohol or have confusion and shaking due to alcohol withdrawal
suffer from convulsions, fits or seizures
have a head injury, brain tumour, increased pressure in your head or spine
have sudden, severe abdominal pain
have a condition where your stomach empties more slowly than it should or your small bowel does not work properly
have an obstruction of the bowel or a condition where it could occur
have severe kidney or liver disease or a disease of the brain caused by liver disease
are about to have an operation or have had one within the last 24 hours including surgery on your spine for pain relief
take a medicine for depression called a 'monoamine oxidase inhibitor' or have taken any in the last two weeks.
Do not take MS Mono capsules if you are allergic to morphine, opioid painkillers, or any of the ingredients listed at the end of this leaflet.
Do not take this medicine after the expiry date (EXP) printed on the pack.
If you take it after the expiry date has passed, it may not work very well.
Do not take it if the packaging is torn or shows signs of tampering.
Do not take this medicine if you are pregnant or intend to become pregnant whilst taking this medicine.
Like most medicines of this kind, MS Mono capsules are not recommended to be used during pregnancy. Your doctor will discuss the risks of using it if you are pregnant.
Do not give this medicine to a child under one year of age or weighing less than 25 kg.
Safety and effectiveness in children under one year of age or weighing less than 25 kg have not been established.
Before you start to take it
Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.
Tell your doctor if you have or have had any medical conditions, especially the following:
low blood pressure
increased prostate size or difficulty passing urine
problems or recent surgery of your gall bladder or bile duct
inflammation of the pancreas
underactive adrenal glands
underactive thyroid gland
inflammatory bowel disease or recent abdominal surgery
an addiction or history of abuse of alcohol or drugs.
This medicine is not recommended to be taken during labour.
Morphine given to the mother during labour may cause breathing problems in the newborn.
Tell your doctor if you are breastfeeding or planning to breastfeed.
Morphine can pass into the breast milk and can affect the baby. Your doctor can discuss with you the risks involved.
If you have not told your doctor about any of the above, tell them before you start taking MS Mono capsules.
Taking other medicines
Tell your doctor or pharmacist if you are taking any other medicines or dietary supplements, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.
Some medicines, alcohol and MS Mono capsules may interfere with each other. These include:
medicines to treat depression, psychiatric or mental disorders
medicines to treat depression belonging to a group called 'monoamine oxidase inhibitors' must be stopped 14 days before MS Mono capsules are taken
medicines to help you sleep
medicines to put you to sleep during an operation or procedure
medicines to relax your muscles
medicines to prevent or relieve the symptoms of allergy such as antihistamines
propranolol or other medicines to lower blood pressure
gabapentin or barbiturates, medicines to treat seizures
medicines to thin the blood e.g. coumarin derivatives such as warfarin
medicines used to relieve heartburn or treat stomach ulcers such as cimetidine or antacids (take antacids at least two hours before or after taking MS Mono capsules)
medicines to treat Parkinson's disease
medicines to treat urinary incontinence
medicines to stop nausea or vomiting e.g. metoclopramide or prochlorperazine
rifampicin, a medicine to treat tuberculosis
other pain relievers including other opioids
medicines to treat HIV infection and AIDS e.g. ritonavir or zidovudine.
These medicines, dietary supplements or alcohol may be affected by MS Mono capsules, may affect how well MS Mono capsules work or may increase side effects. You may need to use different amounts of your medicines, or take different medicines.
Your doctor or pharmacist has more information on medicines and dietary supplements to be careful with or avoid while taking this medicine.
How to take MS Mono capsules
How much to take
Your doctor will tell you exactly how much to take.
Follow the instructions given to you by your doctor or pharmacist exactly.
How to take it
Swallow MS Mono capsules whole with water.
You can take the capsules before or after a meal.
If you have trouble swallowing, you can open your capsules and sprinkle the pellets onto soft cold food such as yoghurt, custard, apple puree or ice cream. Eat the soft food containing the pellets within 60 minutes and do not chew or crush the pellets. After eating, rinse your mouth to ensure that all the pellets have been swallowed.
The pellets may also be sprinkled into a glass of liquid (milk, orange juice or water). Drink the liquid containing the pellets within 60 minutes and do not chew or crush the pellets. If some of the pellets stick to the glass, add more liquid and swirl to pick up any remaining pellets before drinking.
Do not chew or crush them.
The pellets may release all their contents at once if the pellets are chewed or crushed which can be dangerous and cause serious problems, such as an overdose which may be fatal.
You must only take MS Mono capsules by mouth.
Taking this medicine in a manner other than that prescribed by your doctor can be harmful to your health.
When to take it
Take MS Mono capsules every 24 hours.
Take MS Mono capsules regularly to control the pain.
Taking them at the same time each day will assist in ensuring the best effect in improving your pain. If, however, you begin to experience worsening pain and you are taking your MS Mono capsules as prescribed, contact your doctor as your dosage may have to be reviewed.
How long to take it
Continue taking your medicine for as long as your doctor tells you.
If you stop taking this medicine suddenly, your pain may worsen and you may experience withdrawal symptoms such as:
loss of appetite, nausea, stomach cramps or diarrhoea
fast heart rate
sneezing or runny nose
chills, tremors, shivering or fever
increased sweating and yawning
nervousness or restlessness.
If you forget to take it
If you forget to take your dose, contact your doctor or pharmacist for advice.
Do not take a double dose to make up for the dose you have missed.
This will increase the chance of you getting unwanted side effects.
If you have trouble remembering when to take your medicine, ask your pharmacist for hints.
For example, take your medicine at the same time each day.
If you take too much (overdose)
Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at your nearest hospital, if you think that you or anyone else may have taken too many MS Mono capsules.
Do this even if there are no signs of discomfort or poisoning.
You may need urgent medical attention.
Keep telephone numbers for these places handy.
You should also follow the above steps if someone other than you has accidentally taken the capsules that were prescribed for you.
If someone takes an overdose they may experience difficulties in breathing, become drowsy and tired, lack muscle tone, have cold or clammy skin, have constricted pupils, have very low blood pressure or slow heart rate, and possibly may even become unconscious or die.
When seeking medical attention, take this leaflet and any remaining capsules with you to show the doctor. Also tell them about any other medicines or alcohol which have been taken.
While you are taking it
Things you must do
Take MS Mono capsules exactly as your doctor has prescribed.
Before you start on a new medicine, remind your doctor and pharmacist that you are taking MS Mono capsules.
Tell any other doctors, dentists and pharmacists who treat you that you are taking this medicine.
If you are about to have any blood tests, tell your doctor that you are being given this medicine.
It may interfere with the results of some tests.
If you are going to have surgery, tell the surgeon or anaesthetist that you are taking this medicine.
It may affect other medicines used during surgery.
If you become pregnant while taking this medicine, tell your doctor immediately.
Keep all of your doctor's appointments so that your progress can be checked.
Tell your doctor if your pain is getting worse. Also tell your doctor if you are having any problems or difficulties while you are being treated with MS Mono capsules.
Tolerance to morphine may develop which means that the effect of this medicine may decrease. If this happens, your doctor may review your dose so that you get adequate pain relief.
Keep enough MS Mono capsules with you to last over weekends and holidays.
Things you must not do
Do not drink alcohol while you are taking MS Mono capsules.
Drinking alcohol whilst taking MS Mono capsules may make you feel more sleepy and increase the risk of serious side effects, such as shallow breathing with the risk of stopping breathing and loss of consciousness.
Do not take MS Mono capsules to treat any other complaint unless your doctor tells you to.
Do not give your medicine to anyone else, even if they have the same condition as you.
Do not stop taking your medicine, exceed the dose recommended or change the dosage without checking with your doctor.
Over time your body may become used to morphine. If you stop taking it suddenly, your pain may worsen and you may experience unwanted side effects such as withdrawal symptoms. This is called physical dependence.
If you need to stop taking this medicine, your doctor will gradually reduce the amount you take each day, if possible, before stopping the medicine completely.
Things to be careful of
Do not drive or operate machinery until you know how MS Mono capsules affect you.
MS Mono capsules may cause drowsiness, dizziness, hallucinations, confusion, vision problems or may affect alertness. If you are affected, you should not drive or operate machinery. Discuss these effects with your doctor.
Be careful if you are elderly, unwell or taking other medicines.
Some people may experience side effects such as drowsiness, dizziness and unsteadiness, which may increase the risk of a fall.
If you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly.
Standing up slowly will help your body get used to the change in position and blood pressure. If this problem continues or gets worse, talk to your doctor.
Tell your doctor if you suffer from nausea or vomiting when taking MS Mono capsules.
If you vomit after taking your dose, your pain may come back as you may not have absorbed your medicine. If this happens speak to your doctor. Your doctor may prescribe some medicine to help stop vomiting.
Tell your doctor if taking MS Mono capsules causes constipation.
Your doctor can advise you about your diet, the proper use of laxatives or alternative treatments and suitable exercise you can do to help manage this.
There is potential for abuse of morphine and the development of addiction to morphine. It is important that you discuss this issue with your doctor.
All medicines may have some unwanted side effects. Sometimes they are serious but most of the time they are not. Your doctor has weighed the risks of using this medicine against the benefits they expect it will have for you.
Do not be alarmed by this list of possible side effects.
Not everybody experiences them.
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking MS Mono capsules.
This medicine helps most people with severe pain, but it may have unwanted side effects in a few people. Other side effects not listed here may also occur in some people.
Ask your doctor or pharmacist to answer any questions you may have.
Tell your doctor if you notice any of the following and they worry you:
mild abdominal problems such as feeling sick (nausea), loss of appetite or constipation
dry mouth or changes in taste
trouble with your balance
new problems with your eyesight
skin rash or itching
absence of menstrual periods, sexual problems, or other hormonal changes
muscle twitching or muscle stiffness
swelling, including but not only of legs or ankles.
Tell your doctor as soon as possible if you notice any of the following and they worry you:
stomach discomfort or cramps, vomiting, indigestion or abdominal pain
abnormal thinking or changes in mood
drowsiness, feeling faint or fainting or dizziness especially when standing up
slow or noticeable heartbeats
headache, confusion or hallucinations
unusual weakness or loss of strength
fatigue, generally feeling unwell
changes in passing urine such as the volume passed, pain or feeling the need to urinate urgently.
The above list includes serious side effects that may require medical attention.
If any of the following happen, tell your doctor immediately or go to Accident and Emergency at your nearest hospital:
your breathing slows or weakens
you have an allergic reaction: shortness of breath, wheezing, shallow or difficult breathing; swelling of the face, lips, tongue, throat or other parts of the body; rash, itching or hives on the skin
seizures, fits or convulsions
fast or irregular heartbeats.
The above list includes very serious side effects. You may need urgent medical attention or hospitalisation.
When seeking medical attention, take this leaflet and any remaining capsules with you to show the doctor.
After taking it
Keep your capsules in the blister pack until it is time to take them.
If you take the capsules out of the blister pack they may not keep well.
Keep your capsules in a cool dry place where the temperature stays below 25°C.
Do not store it or any other medicine in the bathroom, near a sink or on a window sill.
Do not leave it in the car.
Heat and damp can destroy some medicines.
Keep it where children cannot reach it.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.
If your doctor tells you to stop taking the capsules or the capsules have passed their expiry date, ask your pharmacist how to dispose of medicines no longer required.
What it looks like
MS Mono® modified release capsules are available in four strengths:
30 mg - light blue, size 4 capsules marked MS OD 30
60 mg - brown, size 3 capsules marked MS OD 60
90 mg - pink, size 2 capsules marked MS OD 90
120 mg - olive, size 1 capsules marked MS OD 120.
MS Mono® capsules are available in cartons containing blister packs of 14 capsules.
30 mg capsules contain 30 mg morphine sulfate.
60 mg capsules contain 60 mg morphine sulfate.
90 mg capsules contain 90 mg morphine sulfate.
120 mg capsules contain 120 mg morphine sulfate.
hydrogenated vegetable oil
The capsule shells contain gelatin and sodium lauryl sulfate.
All MS Mono® modified release capsules are printed in black ink which contains shellac, iron oxide black (E172) and propylene glycol.
In addition, the capsules also contain titanium dioxide and the colourants listed below:
30 mg capsules: E132 (indigo carmine)
60 mg capsules: E132 (indigo carmine) and E172 (iron oxide red and yellow)
90 mg capsules: E127 (erythrosine) and E172 (iron oxide black and red)
120 mg capsules: E132 (indigo carmine) and E172 (iron oxide black and yellow).
This medicine does not contain lactose, sucrose, gluten or tartrazine.