MORPHINE SULFATE. Many people wonder about the uses, forms, and side effects of morphine, and of all the medications used to treat pain, morphine sulfate is perhaps the most misunderstood and the most feared. Commonly used in hospice and palliative care settings to treat people nearing the end of their lives, different concerns often arise than when morphine is used for surgery or in non-hospice settings. This article explores how and why to use liquid morphine (as well as other forms) at the end of life, and the possible side effects you may expect.
Liquid morphine is often provided in a hospice kit so that family or friends can treat their loved one who is dying.1 It’s important to note that you can always contact your hospice nurse or physician if you have questions about the use of morphine.
It may be used for more than one symptom near the end of life.
In palliative care and hospice settings, morphine is one of the most commonly used pain medications because it generally treats pain effectively, and is usually well-tolerated. Moreover, morphine is readily available in most areas and is usually cost-effective.2
Shortness of Breath
It is also effective in treating dysphttps://souldelics.com/nea, or shortness of breath, a symptom experienced by a very large number of people at the end of life and sometimes more distressing than physical pain.3 Morphine can reduce the anxiety associated with shortness of breath but actually improves breathing by dilating blood vessels in the lungs and deepening breaths. Other medications in the hospice kit may reduce anxiety, but can actually worsen dyspnea, MORPHINE SULFATE.
It is usually tolerated well, but can also cause some troublesome, and even serious, side effects.
Common Side Effects
Relatively common but not usually emergent side effects include:4
- Feeling lightheaded
- Upset stomach
If your loved one experiences any of these symptoms, it’s important to talk to your hospice nurse or physician. Often times these side effects can be controlled or alleviated with other treatments, so your loved one can continue to get the pain-relieving benefit of the drug. Examples include using an anti-nausea medication for nausea and vomiting, or a stool softener with or without a laxative for constipation, MORPHINE SULFATE.
Serious Side Effects
All serious side effects of morphine use should be reported to your doctor immediately, and can include:
- Slow, shallow, or irregular breathing
- Blue or purple color to the skin
- Fast or slow heartbeat
- Hallucinations (seeing things or hearing voices that do not exist)
- Blurred vision
- Tightness in the throat
- Difficulty swallowing
- Swelling of the arms, hands, feet, ankles, or lower legs
It’s important to note that many people appear to hallucinate at the end of life whether they are receiving morphine or not.
Forms and Administration
It comes in several forms, including liquid or tablet form, which makes it the pain-relieving drug of choice in many end-of-life situations. The forms of morphine can include:
Oral Morphine Solutions
Oral (liquid) morphine solutions are commonly used in palliative care and hospice settings, and often are included in the “hospice kit” provided to loved ones to administer if or when needed.2
Liquid morphine is easy to give and can be concentrated to administer larger doses of the drug using smaller amounts of liquid. In addition, some people are unable to swallow pills because of their illness, due to a decreased level of consciousness, or because of morphine’s side effect of sedation. In these situations, people can usually tolerate the smaller amount of liquid needed to alleviate their pain and/or make them feel comfortable, MORPHINE SULFATE.
Time to Onset and How Long it Lasts
An oral/liquid morphine solution typically starts working quickly—usually within 15 minutes—and lasts for roughly 4 hours, although some people might find they require morphine more often.
Morphine tastes bitter, which is most noticeable in the liquid form in contrast to pill form. Because the concentrated liquid is usually given in small amounts, it is recommended that morphine not be mixed with other liquids. Most people tolerate receiving the medication alone or by “chasing it” with a drink of their choice.
Method of Administration
Oral morphine solution should be given only with a dosing spoon or dropper provided by the pharmacy.4
Because it is highly concentrated, it’s important to get the dose as accurate as possible.
If you are unsure about the right dosing, ask your nurse or another healthcare provider to demonstrate for you. Some hospice nurses carry a “sample bottle” of morphine (without the drug) with them that allows them to demonstrate how to draw up the correct dose and use the dropper. If you have any questions at all, ask your hospice nurse to show you how it is done, MORPHINE SULFATE.
Tablet or Capsule Morphine
Morphine tablets come in both rapid- and extended-release forms.
Rapid Release Tablets
The-release tablets work similarly to an oral/liquid morphine solution in that they have a relatively rapid onset of action but last for only around four hours. Rapid-release tablets can be crushed and mixed with applesauce or pudding for people who have difficulty swallowing tablets. They can also be crushed and administered through a nasogastric (NG) tube.
Extended Release Tablets
Extended-release (ER or XR) tablets can be taken every 12 hours, or even once per day. Extended-release morphine is only used for people who are experiencing continuous moderate to severe pain.4 You should always check with your healthcare provider or pharmacist before crushing an ER tablet or opening an ER capsule, MORPHINE SULFATE.