Morphine – long-acting (modified release)
Other names – MST Continus® or Zomorph®
Who is the leaflet for? What is its aim?
This leaflet is for patients who have been discharged from hospital with long-acting morphine for moderate to severe pain, and where appropriate their relatives or carers. The need for long-acting morphine will have been explained to you before you left hospital. Do not hesitate to ask for more information or to have it repeated, if needed.
Long-acting morphine (also known as modified release) is commonly used for moderate to severe pain from many different causes. It can be used on its own, with short-acting morphine or morphine-like pain relief, or with other types of medicines to treat pain. These medications are safe and are usually effective for controlling your pain when taken properly at the dose recommended for you.
Managing your pain control may be an ongoing process and health professionals will work with you to adjust the medication doses as needed. Health professionals (including doctors, nurses, pharmacists, opticians) will need to know that you are taking these medications, so do inform them even if you are consulting them for an unrelated matter.
Benefits
The medication you have been prescribed will help to manage your pain, enabling you to be more comfortable and active at home. Long-acting morphine preparations should be taken 12 hours apart and should give pain relief for 12 hours.
How to take long-acting morphine
Long-acting morphine is taken twice daily. We recommend you take the first dose when you wake up and the second dose roughly 12 hours later; for example 7 o’clock in the morning and 7 o’clock in the evening.
If you miss a dose then take the dose as soon as you remember, providing this is within four hours of the time you would normally take the medicine. Take your next dose at your normal time.
Do not take a double dose. If you vomit and bring up the medicine, repeat the dose as soon as you feel better providing it is less than four hours since you took the last dose. If this happens again tell your doctor or nurse. If it is more than four hours since you would have taken your tablet, please contact your doctor, nurse or pharmacist for advice.
You must swallow your long-acting morphine without breaking the tablet. If you take a tablet that is broken, crushed or chewed the dose intended to be slowly released over 12 hours may be absorbed rapidly and can lead to breathing difficulty and overdose.
You will also be given a short-acting morphine, usually this is a liquid. If you get (breakthrough) pain between doses of long-acting morphine, you can take a dose of the short-acting morphine. Wait half an hour after having had a dose to allow it to take effect. If you are finding that you need to take more than two or three (breakthrough) doses a day, tell your doctor or nurse as your long-acting morphine dose may need adjusting.
Side-effects
Morphine may cause you to feel sick (nausea) or to vomit when you first start taking it. Taking the medicine with food may help. It is likely that you will have been given an anti-sickness medication (anti-emetic) to take regularly when the painkiller is started. For most patients symptoms of nausea fade as the body gets used to the new drug over two to three days. If they persist or are not controlled by anti-sickness medication, please speak to a doctor or nurse as alternatives that may suit you better are available.
Morphine may increase the risk of constipation and you may have been prescribed a laxative to take regularly whilst you are on morphine. Maintaining a good fluid intake, being active and having fibre in your diet will also help.
Feeling more sleepy than normal is common in the first few days of taking long-acting morphine or after an increase in the dose taken. This will usually resolve over a few days whilst your body is getting used to the new medication, or higher dose. Please avoid driving and operating machinery if you are affected. If this sleepy feeling does not improve after a few days, or it stops you from being able to read a newspaper or following the plot of a television programme, then please seek medical advice promptly. It may be best to avoid alcohol whilst taking morphine as you are more likely to get side effects, such as feeling sleepy.
If you have a history of lung disease (such as COPD or lung fibrosis) or are known to have a blockage in your airway which affects your breathing, then morphine may cause you to breathe less deeply which could be dangerous if not monitored. In these conditions or if you are concerned about your breathing, please check that your doctor or nurse who is prescribing morphine to you is aware of your condition and they are satisfied that morphine is safe.
These medications can be dangerous if they are taken by those they are not prescribed for. Please keep them out of the reach of children or anyone else who might take them inadvertently. If this happens seek medical advice immediately. They should be stored in the original container to protect from light and below 25°C.
Common questions asked about morphine
No. Morphine is given for different sorts of moderate and severe pain for a short or longer time. If you have cancer, treatment with morphine may be needed to allow you to live as comfortably as possible. Morphine can be taken as long as it’s needed and the dose can be changed over time.
Addition is very rare when morphine is used for pain relief, under the guidance of your doctor or nurse. If you no longer need your morphine, the dose can be gradually and safely reduced by your doctor or nurse.
Morphine should not be stopped abruptly.
Some people find that doing certain activities, such as having a bath or going for a walk brings on the pain. Your doctor or nurse may suggest you try taking a dose of short-acting morphine 30 minutes before starting an activity brings on the pain.
Although morphine is a very good painkiller, it is not helpful for all types of pain and may require adjustments by your doctor or nurse. Sometimes other treatments are needed and
suggested by your medical team.
If you feel unwell in one or more of these ways:
- Feeling more sleepy than usual
- Feeling sick more of the time
- Feeling restless or jumpy
- Experiencing dreams that are more vivid than usual or seem real
tell your doctor or nurse. It may be necessary to reduce your dose of morphine or suggest other treatments to help the pain.
Once you get used to taking morphine and do not feel sleepy or unwell you may be able to drive. You must not drive if you feel that your driving may be impaired, in line with the Driving whilst impaired by a drug legislation. In 2015 the government introduced new legislation Driving under the influence of drugs, The Department of Transport advises patients to carry evidence that you have been prescribed morphine by a doctor in case you are stopped by the police. We advise anyone who is unsure about the effects of their medication, or how the 2015 legislation may affect them, to seek the advice of their doctor, nurse or pharmacist.
If you feel sleepy with morphine or are required to drive, it is advisable to limit or avoid alcohol consumption whilst taking morphine. In general alcohol is more likely to make side effects from taking morphine more likely to happen or more pronounced in their effect, such as an increased feeling of being sleepy, tired or sick.
Tablets or liquids which are no longer needed, or which are past their expiry date should be returned to a pharmacy for disposal.
Alternatives
The team looking after you will continue to manage your pain as well as possible, using a combination of drug and non-drug treatments. If your pain continues despite these treatments, please inform your medical team who will explore thus further and consider alternative options. Being completely free of pain is not always possible, but bring your pain into comfortable levels is the main priority of all treatments. While you are awaiting advice do not alter the amount of your medication that you are taking or stop taking it suddenly.
Contacts and further information
Once you are discharged your GP or community specialist palliative care nurse will be providing support to help you manage your pain and to help you use the morphine as effectively as possible.
References and sources of evidence
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
Other formats
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NHS Foundation Trust
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CB2 0QQ
Telephone +44 (0)1223 245151
https://www.cuh.nhs.uk/contact-us/contact-enquiries/