Brand Name(s):

RMS^® Suppository¶

IMPORTANT WARNING

Morphine rectal may be habit forming, especially with prolonged use. Use morphine exactly as directed. Do not use more of it, use it more often, or use it in a different way than directed by your doctor. While you are using morphine rectal, discuss with your health care provider your pain treatment goals, length of treatment, and other ways to manage your pain. Tell your doctor if you or anyone in your family drinks or has ever drunk large amounts of alcohol, uses or has ever used street drugs, or has overused prescription medications, or if you have or have ever had depression or another mental illness. There is a greater risk that you will overuse morphine if you have or have ever had any of these conditions. Talk to your health care provider immediately and ask for guidance if you think that you have an opioid addiction or call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP.

Morphine may increase the risk that you will experience breathing problems or other serious or life-threatening breathing problems, sedation, or coma if used along with certain medications. Tell your doctor if you are taking or plan to take any of the following medications: benzodiazepines such as alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), and triazolam (Halcion); medications for mental illness, nausea, or pain; muscle relaxants; sedatives; sleeping pills; or tranquilizers. Your doctor may need to change the dosages of your medications and will monitor you carefully. If you use morphine rectal with any of these medications and you develop any of the following symptoms, call your doctor immediately or seek emergency medical care: unusual dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness. Be sure that your caregiver or family members know which symptoms may be serious so they can call the doctor or emergency medical care if you are unable to seek treatment on your own.

Drinking alcohol, taking prescription or nonprescription medications that contain alcohol, or using street drugs during your treatment with morphine rectal increases the risk that you will experience these serious, life-threatening side effects. Do not drink alcohol, take prescription or nonprescription medications that contain alcohol, or use street drugs during your treatment.

Talk to your doctor about the risks of using morphine rectal.

WHY is this medicine prescribed?

Morphine rectal is used to relieve moderate to severe pain. Morphine is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the body senses pain.

HOW should this medicine be used?

Morphine rectal comes as a suppository to insert in the rectum. It is usually inserted every 4 hours. Use rectal morphine at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use morphine exactly as directed.

Your doctor may adjust your dose of morphine during your treatment to control your pain as well as possible. If you feel that your pain is not controlled, call your doctor. Do not change the dose of your medication without talking to your doctor.

Do not stop using morphine without talking to your doctor. Your doctor may decrease your dose gradually. If you suddenly stop using morphine, you may experience withdrawal symptoms such as anxiety; sweating; difficulty falling asleep or staying asleep; chills; shaking of a part of your body that you cannot control; nausea; diarrhea; runny nose, sneezing or coughing; hair on your skin standing on end; or hallucinating (seeing things or hearing voices that do not exist).

To use the suppositories, follow these steps:

Remove the wrapper.
Dip the tip of the suppository in water.
Lie down on your left side and raise your right knee to your chest (a left-handed person should lie on the right side and raise the left knee.)
Using your finger, insert the suppository about 1 inch (2.5 centimeters) into the rectum.
Hold it in place with your finger for a few moments
Stand up after about 15 minutes. Wash your hands thoroughly and resume normal activities.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before using rectal morphine,

tell your doctor and pharmacist if you are allergic to morphine, any other medications, or any of the ingredients in morphine suppositories. Ask your pharmacist for a list of the ingredients.
do not use rectal morphine if you are taking a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), linezolid (Zyvox), methylene blue, phenelzine (Nardil), procarbazine (Matulane), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) or if you have stopped taking any of these medications within the past 2 weeks. Your doctor will probably tell you not to use rectal morphine if you are taking one or more of these medications.
tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); antihistamines (found in cold and allergy medications); medications for seizures; barbiturates such as phenobarbital and primidone (Mysoline); beta-blockers such as propranolol (Hemangeol, Inderal, Innopran); butorphanol; chloral hydrate, chlorpromazine, dextromethorphan (found in many cough medications; in Nuedexta); lithium (Lithobid), medications for migraine headaches such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); methocarbamol (Robaxin), mirtazapine (Remeron); nalbuphine; pentazocine (Talwin); 5HT3 serotonin blockers such as alosetron (Lotronex), dolasetron (Anzemet), granisetron (Kytril), ondansetron (Zofran, Zuplenz), or palonosetron (Aloxi); selective serotonin-reuptake inhibitors such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Prozac, Pexeva), and sertraline (Zoloft); serotonin and norepinephrine reuptake inhibitors such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor); tramadol (Conzip, Ultram, in Ultracet), and tricyclic antidepressants ('mood elevators') such as amitriptyline, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). Many other medications may also interact with rectal morphine, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor what herbal products you are taking, especially St. John's wort and tryptophan.
tell your doctor if you drink or have ever drunk large amounts of alcohol or have had biliary tract or stomach surgery. Also tell your doctor if you have or have ever had a head injury; a brain tumor or any condition that increases the amount of pressure in your brain; seizures; serious or life-threatening breathing problems; asthma; an irregular heartbeat; or heart failure. Your doctor will probably tell you not to use rectal morphine.
tell your doctor if you have ever had major surgery. Also tell your doctor if you have or have ever had mental illness; chronic obstructive pulmonary disease (COPD; a group of diseases that cause gradual loss of lung function) or other breathing problems; prostatic hypertrophy (enlargement of a male reproductive gland); urethral stricture (blockage of the tube that allows urine to leave the body); urinary problems; low blood pressure; Addison's disease (condition in which the body does not make enough of certain natural substances); or thyroid, liver, kidney, pancreatic, intestinal, or gallbladder disease.
tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using morphine, call your doctor.
you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using rectal morphine.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are using morphine.
you should know that morphine may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

What SPECIAL DIETARY instructions should I follow?

Drink plenty of fluids while you are using this medication.

What should I do IF I FORGET to take a dose?

Insert the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not insert a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach.http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online athttps://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

While you are using morphine, you may be told to always have a rescue medication called naloxone available (e.g., home, office). Naloxone is used to reverse the life-threatening effects of an overdose. It works by blocking the effects of opiates to relieve dangerous symptoms caused by high levels of opiates in the blood. You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to use naloxone, and what to do until emergency medical help arrives. Your doctor or pharmacist will show you and your family members how to use the medication. Ask your pharmacist for the instructions or visit the manufacturer's website to get the instructions. If someone sees that you are experiencing symptoms of an overdose, he or she should give you your first dose of naloxone, call 911 immediately, and stay with you and watch you closely until emergency medical help arrives. Your symptoms may return within a few minutes after you receive naloxone. If your symptoms return, the person should give you another dose of naloxone. Additional doses may be given every 2 to 3 minutes, if symptoms return before medical help arrives.

Symptoms of overdose may include the following:

slow, shallow, or irregular breathing
blue or purple color to the skin
drowsiness
loss of consciousness
limp muscles
cold, clammy skin
slow heartbeat
blurred vision
nausea
fainting

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and laboratory. Your doctor may order certain lab tests to check your body's response to morphine.

Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are using morphine rectal.

This prescription is not refillable. If you are using morphine to control your pain on a long-term basis, be sure to schedule appointments with your doctor so that you do not run out of medication. If you are using morphine on a short term basis, call your doctor if you continue to experience pain after you finish the medication.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

^¶ This branded product is no longer on the market. Generic alternatives may be available.

AHFS^® Consumer Medication Information. © Copyright, The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: March 15, 2018.