Side Effects of Duramorph (morphine)

Duramorph (morphine) is a narcotic (opioid) pain-reliever used to treat chronic pain that has been unresponsive to non-narcotic pain medicine. It is similar to hydrocodone, oxycodone, methadone, fentanyl, and other opioids. 

Morphine, like other opioids, stimulates receptors on nerves in the brain to increase the threshold to pain (increasing the amount of stimulation it takes to feel pain) and reduce the perception of pain (the perceived importance of the pain). 

Common side effects of Duramorph include

• dry mouth,
• constipation,
• nausea,
• vomiting,
• drowsiness,
• dizziness, and
• difficulty urinating.

Other side effects of Duramorph include

• pain at the injection site,
• low blood pressure,
• slowed heart rate,
• itching,
• fever,
• confusion,
• headache,
• weakness, and
• decreased oxygen delivery to the body.

Serious side effects of Duramorph include

• anemia with intrathecal injection.

Duramorph has the potential to be habit-forming. Tolerance and physical and psychological dependence may occur with prolonged use. Seizures may result from high doses.

Overdoses may cause

• respiratory depression,
• coma, and
• death.

Drug interactions of Duramorph include alcohol and other sedatives, because combining these with Duramorph can lead to increased sedation and even cause confusion.

• Fluoxetine may increase blood levels and the effect of Duramorph leading to increased side effects.
• Duramorph should also be avoided in patients treated with monoamine oxidase inhibitors (MAOIs) due to enhance toxicity of Duramorph including
  • confusion,
  • high blood pressure,
  • tremor,
  • hyperactivity,
  • coma, and
  • death. 

Duramorph injection should only be given to pregnant women when no other method of controlling pain is available and there are methods to monitor the fetus. Newborns may exhibit withdrawal symptoms if chronic dosing is used. 

Duramorph is excreted in breast milk, however, the American Academy of Pediatrics committee states that it is safe to use while breastfeeding. Consult your doctor.

The most frequent adverse reactions of morphine include:

• dry mouth,
• constipation,
• nausea,
• vomiting,
• drowsiness,
• dizziness, and
• difficulty urinating.

Other side effects include:

• low blood pressure,
• slowed heart rate,
• itching,
• fever,
• confusion,
• headache,
• weakness, and
• decreased oxygen delivery to the body.

Patients may also develop anemia with intrathecal injection, and pain at the injection site. The elderly may be more sensitive to adverse effects. Morphine has the potential to be habit forming. Tolerance and physical and psychological dependence may occur with prolonged use. Seizures may result from high doses. Overdoses may cause respiratory depression, coma, and death.

The most serious adverse experience encountered during administration of Duramorph (morphine injection) is respiratory depression and/or respiratory arrest. This depression and/or respiratory arrest may be severe and could require intervention.

Because of delay in maximum CNS effect with intravenously administered drug (30 min), rapid administration may result in overdosing. Single-dose neuraxial administration may result in acute or delayed respiratory depression for periods at least as long as 24 hours.

Tolerance and Myoclonus

While low doses of intravenously administered morphine have little effect on cardiovascular stability, high doses are excitatory, resulting from sympathetic hyperactivity and increase in circulating catecholamines.

Excitation of the central nervous system, resulting in convulsions, may accompany high doses of morphine given intravenously. Dysphoric reactions may occur after any size dose and toxic psychoses have been reported.

Pruritus

Single-dose epidural or intrathecal administration is accompanied by a high incidence of pruritus that is dose-related but not confined to the site of administration. Pruritus, following continuous infusion of epidural or intrathecal morphine, is occasionally reported in the literature; these reactions are poorly understood as to their cause.

Urinary Retention

Urinary retention, which may persist 10 to 20 hours following single epidural or intrathecal administration, is a frequent side effect and must be anticipated primarily in male patients, with a somewhat lower incidence in females.

Also frequently reported in the literature is the occurrence of urinary retention during the first several days of hospitalization for the initiation of continuous intrathecal or epidural morphine therapy. Patients who develop urinary retention have responded to cholinomimetic treatment and/or judicious use of catheters.

Constipation

Constipation is frequently encountered during continuous infusion of morphine; this can usually be managed by conventional therapy.

Headache

Lumbar puncture-type headache is encountered in a significant minority of cases for several days following intrathecal catheter implantation; this, generally, responds to bed rest and/or other conventional therapy.

Other

Other adverse experiences reported following morphine therapy include 

• dizziness,
• euphoria,
• anxiety,
• hypotension,
• confusion,
• reduced male potency,
• decreased libido in men and women, and
• menstrual irregularities including
  • amenorrhea,
  • depression of cough reflex,
  • interference with thermal regulation and
  • oliguria.

Evidence of histamine release such as urticaria, wheals and/or local tissue irritation may occur. Nausea and vomiting are frequently seen in patients following morphine administration.

Pruritus, nausea/vomiting and urinary retention, if associated with continuous infusion therapy, may respond to intravenous administration of a low dose of naloxone (0.2 mg). The risks of using narcotic antagonists in patients chronically receiving narcotic therapy should be considered.

In general, side effects are amenable to reversal by narcotic antagonists.

NALOXONE INJECTION AND RESUSCITATIVE EQUIPMENT SHOULD BE IMMEDIATELY AVAILABLE FOR ADMINISTRATION IN CASE OF LIFE-THREATENING OR INTOLERABLE SIDE EFFECTS AND WHENEVER Duramorph (morphine injection) THERAPY IS BEING INITIATED.

Drug Abuse And Dependence

Controlled Substance

• Morphine sulfate is a Schedule II narcotic under the United States Controlled Substance Act (21 U.S.C. 801-886).
• Morphine is the most commonly cited prototype for narcotic substances that possess an addiction-forming or addiction-sustaining liability. A patient may be at risk for developing a dependence to morphine if used improperly or for overly long periods of time.
• As with all potent opioids which are µ-agonists, tolerance as well as psychological and physical dependence to morphine may develop irrespective of the route of administration (intravenous, intramuscular, intrathecal, epidural or oral).
• Individuals with a prior history of opioid or other substance abuse or dependence, being more apt to respond to the euphorogenic and reinforcing properties of morphine, would be considered to be at greater risk.
• Care must be taken to avert withdrawal in patients who have been maintained on parenteral/oral narcotics when epidural or intrathecal administration is considered. Withdrawal symptoms may occur when morphine is discontinued abruptly or upon administration of a narcotic antagonist.

Combining alcohol and other sedatives with morphine can lead to increased sedation and even cause confusion.

Fluoxetine (Prozac) may increase blood levels and the effect of morphine leading to increased side effects.

Morphine should also be avoided in patients treated with monoamine oxidase inhibitors (MAOI) due to enhance toxicity of morphine including

• confusion,
• high blood pressure,
• tremor,
• hyperactivity,
• coma, and
• death.

Drugs in this class include

• isocarboxazid (Marplan),
• phenelzine (Nardil),
• tranylcypromine (Parnate),
• selegiline (Eldepryl), and procarbazine (Matulane), and
• linezolid (Zyvox).

Morphine should not be administered within 14 days of stopping an MAOI.