As with all narcotics, a reduction in dosage may be advisable in the elderly, in hypothyroidism, in renal and chronic hepatic disease.
Morphine has to be administered with caution in patients with history of substance abuse, raised intracranial pressure, hypotension with hypovolemia, biliary tract disorders, pancreatitis, severe renal dysfunction, severe cor pulmonale, severe bronchial asthma, severe chronic obstructive lung disease, respiratory depression, inflammatory bowel disorders, prostatic hypertrophy and adrenocortical insufficiency.
The major risk of opioid excess is respiratory depression.
As with all oral morphine preparations, MST Continus should be used with caution postoperatively and following abdominal surgery, as morphine impairs intestinal motility and should not be used until the physician is assured of normal bowel function.
MST Continus tablets should not be used where there is a possibility of paralytic ileus occurring. Should paralytic ileus be suspected or occur during use, MST Continus tablets should be discontinued immediately.
As with all morphine preparations, patients who are to undergo cordotomy or other pain relieving surgical procedures should not receive MST Continus tablets for 24 hrs prior to surgery. If further treatment with MST Continus tablets is then indicated, the dosage should be adjusted to the new postoperative requirements.
The patient may develop tolerance to the drug with chronic use and require progressively higher doses to maintain pain control. Prolonged use of MST Continus may lead to physical dependence and a withdrawal syndrome may occur upon abrupt cessation of therapy. When a patient no longer requires therapy with morphine, it may be advisable to taper the dose gradually to prevent symptoms of withdrawal.
Morphine has a well recognised abuse and addiction profile similar to other strong opioids. Morphine may be sought and abused by people with latent or manifest addiction disorders. The development of psychological dependence to opioid analgesics in properly managed patients with pain has been reported to be rare. Tolerance to analgesic effects may develop upon repeated administration.
The controlled-release tablets must be swallowed whole and not broken, chewed or crushed. The administration of broken, chewed or crushed controlled-release morphine tablets leads to a rapid release and absorption of a potentially fatal dose of morphine. (See Overdosage.)
Abuse of oral dosage forms by parenteral administration can be expected to result in serious adverse events, which may be fatal.
Morphine may lower the seizure threshold in patients with a history of epilepsy.
Effects on the Ability to Drive or Operate Machinery: Morphine may impair the ability to drive and use machines.