Morphine (Oramorph, Sevredol, Zomorph, Actimorph)

Morphine is a type of painkiller. You can only get it on prescription from your doctor. You have it for moderate to severe pain.

 It is also known as:

• Morphgesic SR

• MXL

• Zomorph

• MST Continus

• Sevredol

• Oramorph

• Actimorph

How does morphine work?

Morphine is a type of opioid. Opioids are strong drugs similar to the natural pain killing substances made in our body. These substances are called endorphins. Opioids stop pain messages from travelling along the nerves to the brain. 

Morphine is extracted from opium poppies in a laboratory.

What types of morphine are there?

You have morphine as:

• tablets or capsules

• liquids

• injections

Your doctor, specialist nurse or pharmacist will help you choose the type and dose that best controls your pain. This depends on the pain you have and the amount of drug you need to control it.

Morphine tablets or capsules

Many people take morphine as tablets or capsules. Some tablets dissolve quickly in your mouth. Others you swallow whole with a glass of water. You can take them with or without food. 

If you are having difficulty swallowing the capsules, your healthcare team will explain how to take them.

There are different types of morphine tablets and capsules. If the pain killing effects last a few hours they are short acting. If they last longer, they are called long acting.

There are also different doses. Most tablets and capsules come in different colours to help you tell the doses apart.

Short acting morphine

You usually take short acting morphine every 4 hours. If you are having morphine to manage pain caused by cancer that cannot be cured (palliative care) you might have it every 2 to 4 hours. And some people may need it every hour.

Most people start by having a short acting morphine. This is because it is easier and quicker to adjust the dose. 

Once your pain is under control, you might change to a long acting tablet or capsule.

Long acting morphine

Long acting morphine lasts from 12 to 24 hours per dose.

You might also hear it called:

• prolonged release
• controlled release
• slow release
• modified release

You take long acting morphine either once or twice a day. 

If you take it twice a day, you should take it in the morning and at night. For example at 8am and 8pm. 

It is important you take morphine regularly, even if you aren’t in pain. The long acting morphine can take up to 48 hours to give you a steady dose. So if you stop and start, they will not work as well. 

If you are still having pain when taking long acting morphine, your doctor may prescribe you short acting morphine to take in between the long acting doses. They can then look at how much morphine you have in total over a day and increase the amount of long acting morphine you take.

Liquid morphine

Liquid morphine is a type of short acting morphine. It comes as a syrup. It is also called a suspension.

You might hear liquid morphine called Oramorph.

Morphine injections

Sometimes you might have morphine as an injection. This might be:

• if you can't swallow
• if you feel sick
• during or after a cancer procedure or surgery

Injections under your skin (subcutaneous injection)

You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.

You might have stinging or a dull ache for a short time after this type of injection but they don't usually hurt much. The skin in the area may go red and itchy for a while.

Some people have morphine under the skin continuously through a small needle connected to a pump called a syringe driver. It gives a continuous small amount of morphine. 

Your nurse will change the syringe driver every 24 or 48 hours. This way of having morphine is helpful for people who find it difficult to swallow.  

Injections into your muscle (intramuscular)

You have the injection into a muscle, usually into your buttock or upper thigh.

Injections into a vein (intravenous injection)

You can have morphine injected into your bloodstream.

This might be through a thin short tube (a cannula) that goes into a vein in your arm. Or through a long plastic tube that goes into a large vein in your chest. You may have one of these if you are having cancer drugs such as chemotherapy. This tube can be a:

• central line
• PICC line
• Portacath

Some people have morphine through a pump called a patient controlled analgesia (PCA) machine. The pump is attached to the cannula or tube into your chest. You press a button and the pump gives you a small amount of morphine. The pump then locks for several minutes. When the pump unlocks you can press it again. This means you can control the painkillers yourself.

When do you have morphine?

Your doctor can prescribe you morphine if you have moderate to severe pain. This can include pain:

• from the cancer
• after an operation or procedure to treat the cancer

They may also prescribe you other types of pain killers to have with morphine.

What are the side effects of morphine?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often side effects to morphine can happen depends on how you have it. Some are more common if you have them as an injection.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Slow shallow breathing

This means your body is not getting the oxygen it needs. It is potentially life threatening. Tell your doctor or nurse immediately if you are breathing slowly or not very deeply.

Slow, shallow breathing is more common if you have morphine as an injection. But it can happen with all types of morphine.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Small pupils

You may notice that the black part in the middle of your eyes (pupils) look smaller than normal. This is less common if you have long acting morphine or morphine as an injection.   

Mood changes

This includes feeling extremely happy or feeing unhappy and agitated. Less often you might have mood swings, feel less active than normal or you might feel really active.

Some people can have difficulty processing or expressing their thoughts.

Confusion, sleepiness and hallucinations

Confusion, sleepiness or extreme lack of energy (lethargy) and seeing or hearing things that aren't there (hallucinations) can be a possible side effect of this treatment. If you have any of these, it is important to tell your doctor or nurse straight away.

These are more common if you have morphine as an injection.

Excessive sweating

You sweat to keep your body cool. Morphine can make you sweat more than needed. Doctors call this hyperhidrosis. Wearing loose fitting clothing made from natural materials such as cotton can help improve your symptoms.

Itchy skin

You might feel itchy when you take morphine.

Less often you might get raised itchy bumps on your skin. This can happen if you are having an allergic reaction to the morphine.

Tell your doctor or nurse straight away if you have any of these symptoms. They can give you some medicine to help.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• difficulty sleeping
• dizziness or vertigo  
• headaches
• sudden jerking of the body due to muscle contractions
• extreme tiredness and weakness
• loss of appetite
• generally feeling unwell
• tummy (abdominal) pain
• taste changes
• dry mouth
• fits (seizures) – tell your doctor straight away if this happens
• indigestion - symptoms include heartburn, bloating and burping
• not being able to pee or pass enough urine – especially if you have other problems that make peeing difficult
• high pressure around your brain - symptoms include a headache, being sick and eye sight changes. You should see a doctor straight away if you have these symptoms
• being very sensitive to pain and other sensations such as touch, heat and pressure
• less interest in sex
• erection problems
• eye problems - including blurred vision or involuntary eye movements
• tightening of the muscles that line the airway (bronchospasm)
• fluid on the lungs making it difficult to breathe
• a slow or fast heart beat
• low blood pressure – you might feel dizzy, lightheaded or faint. This might happen when you stand up
• decreased bowel movement which can cause abdominal pain
• sudden swelling, commonly in the face – this may be due to an allergic reaction. Tell your doctor or nurse straight away if you get any sudden swelling
• redness (flushing) of the face

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening. Alert your nurse if you notice any of these symptoms
• stiff muscles
• tingling or numbness in the skin
• fainting
• high blood pressure
• swelling from a build up of fluid in the arms or legs
• spasms in the urethra

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

This treatment may harm a baby developing in your womb. It is important not to become pregnant while you are having treatment. Talk to your doctor or nurse about effective contraception before starting treatment.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Tolerance and addiction

People taking morphine for weeks or months can develop a physical dependence. This causes withdrawal symptoms if morphine is stopped. 

Your doctor or nurse will advise you how to reduce the morphine dose gradually if necessary. Don't stop taking morphine suddenly. 

Some people can also develop a psychological dependence (addiction) to morphine. This may be more likely in people who have problems with alcohol or drug use. 

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.