Mst Continus ® 10 mg/30 mg/60 mg/100 mg Tablets

Morphine belongs to a group of medicines called analgesics or 'painkillers'. MST CONTINUS ® is intended for relief of severe pain that cannot be controlled by non-narcotic analgesics.

Do not take MST Continus ® if:

• you are pregnant or breastfeeding;
• you are hypersensitive or allergic to morphine, or any of the other ingredients of the tablets;
• you are taking a type of medicine known as a monoamine oxidase inhibitor (examples include tranylcypromine, phenelzine, isocarboxazid, moclobemide and linezolid), or if you have taken this type of medicine in the last two weeks;
• you have any breathing difficulties or a history of asthma. You must not use this medicine during an asthma attack. Wait until the asthma attack has passed and you are fully recovered before resuming treatment;
• MST CONTINUS ® tablets must not be given to children;
• you have a head injury or have increased pressure inside your skull;
• you recently had an operation of the organs that participate in secretion (the liver), storage (the gallbladder), and delivery of bile (hepatic and bile ducts) into the beginning portion of the small intestine;
• you have a disease of the liver;
• before an operation, or for the first 24 hours after an operation;
• a person is in a coma;
• you are an alcoholic;
• whilst consuming alcoholic beverages at the same time;
• you have a condition called phaeochromocytoma (a rare tumour of the adrenal gland, which results in the release of higher quantities of hormones);
• you have a condition called paralytic ileus (obstruction of the intestines) or delayed emptying of the stomach.

Warnings and precautions

Take special care with MST Continus ®: Also tell your doctor or pharmacist if you have any condition in the list below:

• Breathing problems such as asthma, chronic bronchitis or impaired lung function;
• Thyroid problems;
• Kidney problems;
• Liver problems;
• Inflammatory bowel disease;
• Problems with your gall bladder;
• Any stomach problems (such as delayed gastric emptying or acute abdomen);
• Convulsive disorders (diseases that cause fits, such as epilepsy);
• If you have any problems with your biliary tract or bile ducts;
• Low blood pressure;
• If you have a condition called myasthenia gravis (a condition characterised by muscle weakness);
• A severe heart problem after long-term lung disease (severe cor pulmonale);
• Pancreatitis (inflammation of the pancreas);
• Adrenocortical insufficiency (poor adrenal gland function);
• Prostatic hypertrophy (enlargement of the prostate);
• An addiction to alcohol or drugs;
• A history of alcohol or drug abuse, or you have previously suffered from withdrawal symptoms such as agitation, anxiety, shaking and sweating upon stopping taking alcohol or drugs;
• Sickle cell disease;
• Constipation.

MST CONTINUS ® tablets may affect the results of blood tests to check that your liver is working properly. You may develop a tolerance to morphine with long-term use and require progressively higher doses of MST CONTINUS ® to maintain your pain control. Long-term use of MST CONTINUS ® may lead to physical or psychological dependence (addiction) and you may suffer from withdrawal symptoms when you suddenly stop taking the medication. If you no longer require therapy with MST CONTINUS ®, your doctor will gradually reduce your dose to reduce or prevent the symptoms of withdrawal. Increased sensitivity to pain (hyperalgesia), which does not respond to increased doses of MST CONTINUS ®, particularly at high doses, may require a dose reduction or a change of medication. Abuse of MST CONTINUS ® by means of injection can be expected to result in serious side effects, which may include death.

Do not share medicines prescribed for you with any other person. Always take MST CONTINUS ® tablets exactly as your doctor has told you. Check with your doctor or pharmacist if you are unsure.

Your doctor will tell you how long your treatment with MST CONTINUS ® tablets will last. Do not stop your treatment early. If you have the impression that the effect of MST CONTINUS ® tablet is too strong or too weak, talk to your doctor or pharmacist. If you find that you are still in pain whilst taking MST CONTINUS ® tablets discuss this with your doctor.

You should take your tablets every 12 hours. For instance, if you take a tablet at 8 o'clock in the morning, you should take your next tablet at 8 o'clock in the evening. Swallow your tablets whole with water. Do not crush or chew them.

WARNING

MST CONTINUS ® IS A SUSTAINED RELEASE FORMULATION. THE TABLETS MUST BE SWALLOWED WHOLE AND MUST NOT BE CRUSHED, CHEWED, OR DISSOLVED DUE TO THE RISK OF RAPID RELEASE AND ABSORPTION OF A POTENTIALLY FATAL DOSE OF MORPHINE.

If you take more MST Continus ® than you should call your doctor or local hospital straight away. People who have taken an overdose may feel very sleepy and sick. They may also have breathing difficulties leading to unconsciousness or even death and may need emergency treatment in hospital. When seeking medical attention make sure that you take this leaflet and any remaining tablets with you to show the doctor. In the event of overdosage, consult your doctor or pharmacist. If neither is available, contact the nearest hospital or poison control centre.

If you forget to take MST Continus ® If you remember within 4 hours of the time your tablet was due, take your tablet straight away. Take your next tablet at your normal time. If you are more than 4 hours late, please call your doctor for advice. The doctor may give you another painkiller until you are due to take your next tablet.

If you stop taking MST Continus ® You should not suddenly stop taking these tablets unless your doctor tells you to. If you want to stop taking your tablets, discuss this with your doctor first, who will reduce the dose gradually, so you do not experience unpleasant effects.

MST CONTINUS ® tablets can have side effects. Not all side effects reported for MST CONTINUS ® are included in this leaflet. Should your general health worsen or if you experience any untoward effects while taking MST CONTINUS ®, please consult your health care provider for advice. MST CONTINUS ® tablets can cause allergic reactions. Tell your doctor immediately if you get any sudden wheeziness, difficulties in breathing, swelling of the eyelids, face or lips, rash or itching especially those covering your whole body.

There is a risk that you may become addicted or reliant on MST CONTINUS ® tablets.

Frequent side effects

• Most people will develop constipation when they take MST CONTINUS ® tablets. Your doctor can prescribe a laxative to overcome this problem. You can also increase your daily intake of fibre (beans, whole grains, vegetables);
• You may feel sick (nauseous) or vomit (be sick) when you take your tablets. This should wear off after a few days. Your doctor can prescribe an anti-vomiting medicine if it causes problems;
• You may find that you cannot concentrate or that you feel more sleepy than normal when you start taking your tablets or when your dose is increased;
• Dry mouth, loss of appetite and weight loss (anorexia), abdominal pain or discomfort;
• Headache, confusion, difficulty in sleeping, dizziness;
• A feeling of unusual weakness;
• Involuntary muscle contractions or spasms;
• Exacerbation of pancreatitis (increase in severity of or increase in symptoms associated with inflammation of the pancreas, this can cause severe pain in the abdomen and back);
• Rash or itchy skin;
• Sweating;
• Generally feeling unwell or tired.

Less frequent side effects

• Hypersensitivity (allergic) reactions;
• Pulmonary oedema (difficulty in breathing due to fluid on the lungs), respiratory depression (difficulty in breathing);
• Difficulty in breathing or wheezing due to bronchospasm, decreased cough reflex;
• Gastrointestinal disorders (e.g. upset stomach), changes in taste, indigestion;
• Ileus (slowing of the bowel), biliary pain, increased levels of liver enzymes in the blood;
• Fainting;
• Seizures (fits or convulsions);
• Agitation, mood changes, hallucinations, a feeling of extreme happiness, abnormal thoughts;
• Tingling or numbness, muscle stiffness and reduced ability to stretch;
• Increased sensitivity to pain which cannot be improved by increasing the MST CONTINUS ® dose;
• Difficulty in passing urine, urinary tract spasms;
• Impotence, decreased sexual drive, absence of menstrual periods, abnormal ejaculation;
• High or low blood pressure, redness of the face;
• A fast, slow or irregular heartbeat;
• Swelling of the hands, ankles or feet;
• Hives (red, itchy bumps on the skin), itching or dry skin;
• Blurred vision, reduction in size of the pupils in the eye, eye pain;
• Increased tolerance to MST CONTINUS ® tablets (the same dose no longer provides sufficient pain relief), development of dependence;
• Withdrawal symptoms such as agitation, anxiety, shaking or sweating upon stopping taking MST CONTINUS ® tablets;
• Hypothermia (a drop in body temperature);
• Withdrawal symptoms in new-born infants;
• Allodynia (a feeling of pain from sources, which is usually not associated with pain);
• Sleep apnoea syndrome (a sleep disorder in which breathing repeatedly stops and starts);
• Sphincter of Oddi dysfunction (a condition where the sphincter muscle in the intestine does not open when it should, which causes a backup of digestive juices and severe pain in the abdomen);
• Abdominal pain or discomfort due to pancreatitis (swelling or inflammation of the pancreas).

If you notice any side effects not mentioned in this leaflet, please inform your doctor or pharmacist.

Reporting of side effects

If you get side effects, talk to your doctor, pharmacist or nurse. You can also report side effects to SAHPRA via the Med Safety APP (Medsafety X SAHPRA) and eReporting platform (who-umc.org) found on SAHPRA website. By reporting side effects, you can help provide more information on the safety of MST CONTINUS ®. Alternatively report to the following e-mail address: [email protected]

• Store all medicines out of reach of children.
• Store at or below 25 °C.
• Protect from moisture and light.
• There is an expiry date on the blister and carton. Where the expiry date indicates 08 2022, this means that you should not take the tablets after the end of August 2022. After the expiry date, take your tablets to a pharmacy.
• Do not dispose of any unused medicine in the drains or sewerage systems (e.g. toilets).