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feelings), dreams, muscle rigidity, transient hallucinations and disorientation, visual
disturbances, insomnia, increased intracranial pressure
Gastrointestinal: Dry mouth, biliary tract spasm, laryngospasm, anorexia, diarrhea, cramps,
taste alteration, constipation, ileus, intestinal obstruction, dyspepsia, increases in hepatic
enzymes
Cardiovascular: Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness,
syncope, hypotension, hypertension
Genitourinary:Urine retention or hesitance, amenorrhea, reduced libido and/or potency
Dermatologic: Pruritus, urticaria, other skin rashes, edema, diaphoresis
Other: Antidiuretic effect, paresthesia, bronchospasm, muscle tremor, blurred vision, nystagmus,
diplopia, miosis, anaphylaxis, malaise, thinking disturbances, vertigo
OVERDOSAGE
Acute overdosage with morphine can be manifested by respiratory depression, somnolence
progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted
pupils, rhabdomyolysis progressing to renal failure, and, sometimes, bradycardia, hypotension
and death.
The nature of the controlled-release morphine should also be taken into account when treating
the overdose. Even in the face of improvement, continued medical monitoring is required
because of the possibility of extended effects. Deaths due to overdose may occur with abuse and
misuse of MS CONTIN Tablets.
In the treatment of morphine overdosage, primary attention should be given to the re-
establishment of a patent airway and institution of assisted or controlled ventilation. Supportive
measures (including oxygen, vasopressors) should be employed in the management of
circulatory shock and pulmonary edema accompanying overdose as indicated. Cardiac arrest or
arrhythmias may require cardiac massage or defibrillation.
The pure opioid antagonists, such as naloxone, are specific antidotes against respiratory
depression which results from opioid overdose. Naloxone should be administered intravenously;
however, because its duration of action is relatively short, the patient must be carefully
monitored until spontaneous respiration is reliably re-established. If the response to naloxone is
suboptimal or not sustained, additional naloxone may be administered, as needed, or given by
continuous infusion to maintain alertness and respiratory function; however, there is no
information available about the cumulative dose of naloxone that may be safely administered.
Opioid antagonists should not be administered in the absence of clinically significant respiratory
or circulatory depression secondary to morphine overdose. Such agents should be administered