Moderate, acute and chronic pain require stronger medications, including drugs belonging to the category of narcotic analgesics. Morphine is one among the most popular and commonly used opioid agonist for pain management. In use since approval in 1941, morphine belongs to the category of opioid agonist, that was first sourced from poppy seeds. By virtue of its tolerance, the possibility of withdrawal symptoms and the opportunity for it to be abused, there was a certain amount of apprehension among users. However, it is still prescribed for cases that require a strong analgesic. Here is an in-depth look at the drug in injection form and the side effects of morphine, to help prevent and mitigate undesirable effects.

Overview, mechanism of action and its side effects

Despite the availability of semi-synthetic opioids, morphine continues to be a popular prescription. The medication works on the central nervous system to bring about pain relief. The main mechanism of action of the drug is attributed to the morphine-6 glucuronide, with the metabolites working as agonists of opioid receptors.  The sequence of actions results in the activation of the reward pathways, which help mitigate pain. Similarly, the action of the drug on mu-opioid receptor is responsible for the addiction and the withdrawal symptoms associated with the medication. These effects are typically regarded as side effects of morphine that are of concern.

interactions with other drugs

The possibility of drug interactions and side effects of morphine exist when the analgesic is administered alongside other medication. Depending on the role of the medications that conflict, and the criticality, one of the medications may be stopped, altered or the administration schedule may be altered to prevent or mitigate the effects of drug interactions. The possibility of interactions with certain medications are relatively high and it may be necessary to either discontinue, or change the following medications when morphine is to be administered. For instance, individuals on nalmefene, samidorphan, naltrexone and safinamide are generally taken off the medication or prescribed alternative medications when morphine is to be administered.

Other instances of drug interactions that trigger side effects of morphine also exist with certain categories of medications. However, the effects may be mild or manageable in nature, and the treating specialists typically either reduce the dosage or alter the schedule to avoid strong interactions. For instance, medications such as Alvimopan, Amitriptyline, Azithromycin, Bromazepam, Butabarbital, Cannabidiol, Carvedilol, Cetirizine, Chlorpromazine, Clopidogrel, Cyclosporine, Desmopressin, Dextroamphetamine, Diazepam, Diltiazem, Doxylamine, Erythromycin, Fentanyl, Gabapentin, Hydrocodone, Itraconazole, Levorphanol, Oxycodone, Loxapine, Meptazinol, Methohexital, Mirtazapine, Naloxone, Nitrous Oxide, Opium, Palonosetron, Quazepam, Remifentanil, Ritonavir, Sertraline, Sufentanil, Thiopental, Ticagrelor, Tramadol, Venlafaxine, and Zolmitriptan may be altered to avoid interactions. This is not an exhaustive list, but represents only a small section of the medications with possible interactions.

In addition to the above, individuals with certain health conditions or ailments are also advised against taking the drug to prevent side effects of morphine. For instance, the medication is not administered for patients diagnosed with problems in the adrenal gland, asthma, COPD, BPH, or gall bladder disease. Similarly, individuals with a history of over indulgence or dependence on alcohol are also not recommended morphine. Other conditions that could trigger side effects of morphine include patients with heart conditions, history of head injuries, underactive thyroid, slow rate of breathing, hypotension, seizures, kidney and liver ailments.

Common precautions to avoid side effects of Morphine

By virtue of the mechanism of action of the drug, it is expected to amplify the effects of alcohol, or other medications belonging to the category of CNS depressants. For instance, individuals on antihistamines or medications that are typically prescribed for managing cold may experience heightened side effects of the medications. This also includes sedatives prescribed or purchased over the counter and medications prescribed for relaxing muscles. The side effects of morphine include an increase in the effects of anesthetics or dental anesthetics when taken along with morphine.  As mentioned above, individuals on morphine for considerably longer periods may end up getting habituated to the effects of the medication – the effect on the reward pathways.

In addition to the above, patients may experience constipation that is severe in nature, when on morphine for a long time. To avoid this condition, it may be necessary to use laxatives, and consume adequate fluids to offset the possibility of constipation. Patients are also advised to increase intake of fiber to ease the problem of constipation when morphine is taken for a long time. Other precautions to avoid side effects of morphine include avoiding the urge to rise suddenly from a seated or reclining position. There is the possibility of patients feeling dizzy or experiencing a lightheaded feeling. Patients on the medication are advised to avoid handling or operating heavy machinery, or driving, as the degree of alertness among patients may be impacted considerably, affecting reflexes.

Patients planning to undergo surgical procedures that involve the use of morphine are advised to inform the treating team of specialists about use of medications that interact, or the presence of conditions mentioned above. The possibility of side effects of morphine manifesting in patients undergoing procedures exists when the drug is administered along with other medications. Due to the recorded and known withdrawal effects of the medication, patients are advised to avoid abrupt stoppage of the drug, when taken over a long period. The dosage is to be gradually tapered off, before being fully discontinued. Sudden discontinuation may result in possible withdrawal symptoms that may aggravate gradually. Common withdrawal symptoms include pain in the abdomen, fever or anxiety that is not attributed to other conditions. Individuals may also experience tremors, unexplained sweating, feelings of nausea and possible running nose.

Categories of patients who need to exercise caution to avoid side effects

Patients with a history of allergies to medications, certain ingredients in medications, food products, or preservatives, need to intimate this to the treating specialist. Adequate studies have not been conducted to determine the safety or the side effects of morphine on infants. It is therefore essential to avoid the medications, especially administering of injections in the back, among pediatric patients. The effects of morphine, like all other medications, may be stronger on elderly patients. This is due to the age-related impairment if functions of various organs in the body. Consequently, it is essential to modify the dosages accordingly among geriatric patients, as per the actual age, health condition and presence of other ailments. Women who are breastfeeding are also to take precautions, as safety of the drug has not been adequately studied among breastfeeding mothers.

Typical methods of administration of morphine shots

Morphine injections are administered in four different manners, depending on the patient, and the condition. For instance, it can be administered under the skin, in what is medically known as a subcutaneous injection. It can also be administered as an intra muscular injection, into the muscles. The third option is the administration of morphine through the insertion of a needle or a catheter into the back of the patient. As mentioned earlier, injections in the back are not suitable for youngsters or children, and one of the other two options are to be chosen. The fourth option is the intravenous administration of the injection. To avoid side effects of morphine, the medication is typically administered through a couple of shots, following which, it is replaced by oral formulations.

Commonly reported side effects

The undesirable effects of the injection are broadly classified into commonly occurring effects, and rarely occurring effects. Commonly occurring effects typically do not need medical attention or intervention and may resolve naturally in a few days. Effects that occur rarely may sometimes require medical intervention, depending on the intensity or the persistent nature of the effects. It is not out of place to mention that the occurrence of side effects may be a possibility but may not necessarily affect all individuals. For instance, some individuals may not experience any side effects whatsoever, while others may be prone to undesirable outcomes. Commonly reported side effects of morphine include difficulty in breathing normally, or an abnormal change in the breathing rate. It is also possible that the respiration rate suddenly spikes or reduces without any apparent reason.

Other possible conditions include discoloration of the skin or the lips. The lips may turn pale in color, and the fingernails of the patients may also change in color.  There is also the possibility of individuals experiencing blurred vision, without any attributable condition. The individual may also experience difficulty while passing urine, or experience pain during urination. Abnormal tiredness is also a possibility, while patients may also experience dizzy feelings or a light headed feeling when on the medication. Apart from the above side effects of morphine, there is also the possibility of individuals ending up with overdose relation complications. Most of the symptoms of overdose are similar to the commonly reported side effects of morphine. Additional symptoms that are indicative of overdose include possible loss of consciousness, and reduced blood pressure. The patient is also likely to record lower pulse rate as a result of drug overdose.

Side effects of morphine that are not a cause for concern

Individuals tend to consider side effects of morphine as serious. However, some of the possible undesirable effects of morphine are not serious in nature and do not require any kind of medical intervention. The mild complications typically resolve naturally, or when the body begins to adopt itself to the mechanism of action of the medication. For instance, feelings of anxiety or confusion are a possibility, but may not be a cause for concern. Similarly, missed periods, headache, disinterest in sex, and other changes in menstruation are relatively minor in nature and will either resolve naturally, or the body may adjust to the changes.

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