• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What MST Continus tablets are and what they are used for
2. What you need to know before you take MST Continus tablets
3. How to take MST Continus tablets
4. Possible side effects
5. How to store MST Continus tablets
6. Contents of the pack and other Information

• you are allergic to morphine or any of the other ingredients of this medicine (listed in section 6);
• you have breathing problems, such as obstructive airways disease, respiratory depression, or severe asthma. Your doctor will have told you if you have these conditions. Symptoms may include breathlessness, coughing or breathing more slowly or weakly than expected;
• you have a condition where the small bowel (part of your gut) does not work properly (paralytic ileus), your stomach empties more slowly than it should (delayed gastric emptying) or you have severe pain in your abdomen;
• you have a head injury that causes a severe headache or makes you feel sick. This is because the tablets may make these symptoms worse or hide the extent of the head injury;
• you have recent onset liver disease;
• you are taking a type of medicine known as a monoamine oxidase inhibitor (examples include tranylcypromine, phenelzine, isocarboxazid, moclobemide and linezolid), or you have taken this type of medicine in the last two weeks;
• the patient is under one year of age.

If you are going to have an operation, please tell the doctor at the hospital that you are taking these tablets.

Tolerance, dependence, and addiction

This medicine contains morphine which is an opioid medicine. Repeated use of opioids can result in the drug being less effective (you become accustomed to it, known as tolerance). Repeated use of MST Continus tablets can also lead to dependence, abuse, and addiction, which may result in life-threatening overdose. The risk of these side effects can increase with a higher dose and longer duration of use.

Dependence or addiction can make you feel that you are no longer in control of how much medicine you need to take or how often you need to take it.

The risk of becoming dependent or addicted varies from person to person. You may have a greater risk of becoming dependent on or addicted to MST Continus tablets if:

• You or anyone in your family have ever abused or been dependent on alcohol, prescription medicines or illegal drugs (“addiction”).
• You are a smoker.
• You have ever had problems with your mood (depression, anxiety, or a personality disorder) or have been treated by a psychiatrist for other mental illnesses.

If you notice any of the following signs whilst taking MST Continus tablets, it could be a sign that you have become dependent or addicted:

• You need to take the medicine for longer than advised by your doctor
• You need to take more than the recommended dose
• You are using the medicine for reasons other than prescribed, for instance, ‘to stay calm’ or ‘help you sleep’
• You have made repeated, unsuccessful attempts to quit or control the use of the medicine
• When you stop taking the medicine you feel unwell, and you feel better once taking the medicine again (‘withdrawal effects’)

If you notice any of these signs, speak to your doctor to discuss the best treatment pathway for you, including when it is appropriate to stop and how to stop safely (See section 3, If you stop taking MST Continus tablets).

Talk to your doctor or pharmacist before taking these tablets if you:

• are or have ever been addicted to opioids, alcohol, prescription medicines, or illegal drugs;
• have previously suffered from withdrawal symptoms such as agitation, anxiety, shaking or sweating when you have stopped taking alcohol or drugs;
• feel you need to take more MST Continus tablets to get the same level of pain relief, this may mean you are becoming tolerant to the effects of this medicine or are becoming addicted to it. Speak to your doctor who will discuss your treatment and may change your dose or switch you to an alternative pain reliever;
• have breathing problems, such as impaired lung function or severe bronchial asthma. Your doctor will have told you if you have these conditions. Symptoms may include breathlessness and coughing;
• have a severe heart problem after long-term lung disease (severe cor pulmonale);
• have a head injury, severe headache or feel sick as this may indicate that the pressure in your skull is increased;
• have low blood pressure;
• have an under-active thyroid gland (hypothyroidism);
• have severe kidney or liver problems;
• suffer from, or have ever suffered from epilepsy, seizures, fits or convulsions;
• have inflammation of the pancreas or have problems with your gall bladder due to gall stones;
• have an inflammatory bowel disorder;
• you suffer from constipation;
• have prostate problems;
• experience weakness, fatigue, lack of appetite, nausea, vomiting or low blood pressure. This may be a symptom of the adrenal glands producing too little of the hormone ‘cortisol’, and you may need to take a hormone supplement;
• have loss of libido, impotence or your menstrual cycle stops. This may be because of decreased sex hormone production;
• have sickle cell disease.

Contact your doctor if you experience severe upper abdominal pain possibly radiating to the back, nausea, vomiting or fever as this could be symptoms associated with inflammation of the pancreas (pancreatitis) and the biliary tract system.

Taking this medicine regularly, particularly for a long time, can lead to addiction. Your doctor should have explained how long you will be using it for and when it is appropriate to stop, how to do this safely.

Rarely, increasing the dose of this medicine can make you more sensitive to pain. If this happens, you need to speak to your doctor about your treatment.

Addiction can cause withdrawal symptoms when you stop taking this medicine. Withdrawal symptoms can include restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, loss of appetite, shaking, shivering or sweating. Your doctor will discuss with you how to gradually reduce your dose before stopping the medicine. It is important that you do not stop taking the medicine suddenly as you will be more likely to experience withdrawal symptoms.

Opioids should only be used by those they are prescribed for. Do not give your medicine to anyone else. Taking higher doses or more frequent doses of opioid may increase the risk of addiction. Overuse and misuse can lead to overdose and/or death.

Acute generalized exanthematous pustulosis (AGEP) has been reported in association with MST Continus tablets treatment. Symptoms usually occur within the first 10 days of treatment. Tell your doctor if you have ever developed a severe skin rash or skin peeling, blistering and/or mouth sores after taking MST Continus tablets or other opioids. Stop using MST Continus tablets and seek medical attention immediately, if you notice any of the following symptoms: blistering, widespread scaly skin or pus-filled spots together with fever.

Sleep-related breathing disorders

MST Continus tablets can cause breathing disorders such as sleep apnoea (breathing pauses during sleep) and sleep related hypoxemia (low oxygen level in blood). The symptoms can include breathing pauses during sleep, night awakening due to shortness of breath, difficulties to maintain sleep or excessive drowsiness during the day. If you or another person observes these symptoms contact your doctor. A dose reduction may be considered by your doctor.

You may experience hormonal changes while taking these tablets. Your doctor may want to monitor these changes.

Concomitant use of MST Continus tablets and sedative medicines, such as benzodiazepines or related drugs, increases the risk of drowsiness, difficulties in breathing (respiratory depression), coma and may be life-threatening. Because of this, concomitant use should only be considered when other treatment options are not possible. However, if your doctor does prescribe MST Continus tablets together with sedative medicines, the dosage and duration of concomitant treatment should be limited by your doctor.

Please tell your doctor about all sedative medicines you are taking and follow your doctor’s dosage recommendation closely. It could be helpful to inform friends or relatives to be aware of the signs and symptoms stated above. Contact your doctor when experiencing such symptoms.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. If you take these tablets with some other medicines, the effect of the tablets or the other medicine may be changed.

MST Continus tablets must not be used together with a monoamine oxidase inhibitor, or if you have taken this type of medicine in the last two weeks (see Section 2 ‘Do not take’)

Tell your doctor or pharmacist if you are taking any of the medicines mentioned below. A large number of drugs can interact with morphine sulfate tablets which can significantly alter their effects. These drugs include:

• medicines to help you sleep (for example benzodiazepines, tranquillisers, hypnotics or sedatives);
• medicines to treat psychiatric or mental disorders (such as phenothiazines);
• muscle relaxants;
• medicines to treat high blood pressure;
• cimetidine to treat stomach ulcers, indigestion or heartburn;
• certain types of medicines to stop you feeling or being sick;
• medicines used to prevent or relieve the symptoms of an allergy (antihistamines);
• rifampicin to treat tuberculosis;
• ritonavir to treat HIV;
• medicines to treat Parkinson’s disease;
• gabapentin or pregabalin to treat epilepsy and pain due to nerve problems (neuropathic pain);
• some medicines used to treat blood clots (e.g. clopidogrel, prasugrel, ticagrelor) may have delayed and decreased effect when taken together with morphine.

Also tell your doctor if you have recently been given an anaesthetic.

Drinking alcohol whilst taking MST Continus tablets may make you feel more sleepy or increase the risk of serious side effects such as shallow breathing with a risk of stopping breathing, and loss of consciousness. It is recommended not to drink alcohol while you are taking MST Continus tablets.

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Do not take MST Continus tablets if you are pregnant or think you might be pregnant unless you have discussed this with your doctor and the benefits of treatment are considered to outweigh the potential harm to the baby. If you take MST Continus tablets during pregnancy your baby may become dependent and experience withdrawal symptoms after the birth which may need to be treated, such as high-pitched crying, irritability and restlessness, shaking (tremor), feeding difficulties and sweating.

Do not take MST Continus tablets while you are breastfeeding as morphine passes into breast milk and will affect your baby.

These tablets may cause a number of side effects such as drowsiness which could affect your ability to drive or use machinery (see section 4 for a full list of side effects). These are usually most noticeable when you first start taking the tablets, or when changing to a higher dose. If you are affected, you should not drive or use machinery.

• Do not drive while taking this medicine until you know how it affects you.
• It is an offence to drive if this medicine affects your ability to drive.
• However, you would not be committing an offence if:
  • The medicine has been prescribed to treat a medical or dental problem and
  • You have taken it according to the instructions given by the prescriber and in the information provided with the medicine and
  • It was not affecting your ability to drive safely.

Talk to your doctor or pharmacist if you are not sure whether it is safe for you to drive while taking this medicine.

The 5 mg, 10 mg, 15 mg, 30 mg and 60 mg tablets contain lactose which is a form of sugar. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking these tablets.

The 30 mg and 60 mg tablets contain sunset yellow (E110) which may cause allergic reactions.

The usual starting dose is one 30 mg tablet every 12 hours. However, the dose will depend on your age, weight and the severity of your pain. If you are elderly or weigh less than 70 kg your doctor may suggest a lower starting dose. Your doctor will decide how many tablets you should take.

Children over one year of age can take the tablets. The required dose will depend on their weight and severity of pain. This should be discussed with your doctor or pharmacist.

If you find that you are still in pain whilst taking these tablets discuss this with your doctor.

Do not exceed the dose recommended by your doctor. You should check with your doctor or pharmacist if you are not sure.

Call your doctor or hospital straight away as you may need emergency treatment. People who have taken an overdose may feel very sleepy, sick, dizzy or get pneumonia from inhaling vomit or foreign matter (symptoms may include breathlessness, cough and fever). People who have taken an overdose may also have breathing difficulties leading to unconsciousness or even death.

An overdose may result in:

• A brain disorder (known as toxic leukoencephalopathy)

When seeking medical attention make sure that you take this leaflet and any remaining tablets with you to show to the doctor.

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. Do not take a double dose to make up for a forgotten tablet.

Do not suddenly stop taking this medicine. If you want to stop taking this medicine discuss this with your doctor first. They will tell you how to do this, usually by reducing the dose gradually so that any unpleasant withdrawal effects are kept to a minimum. Withdrawal symptoms such as restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, shaking, shivering or sweating may occur if you suddenly stop taking this medicine.

If you notice any of the following signs whilst taking MST Continus tablets it could be a sign that you have become addicted.

• You need to take the medicine for longer than advised by your prescriber;
• You feel you need to use more than the recommended dose;
• You are using the medicine for reasons other than prescribed;
• When you stop taking the medicine you feel unwell, and you feel better once taking the medicine again.

If you notice any of these signs it is important you talk to your doctor.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects, you can help provide more information on the safety of this medicine.

The active ingredient is morphine sulfate. Each tablet contains 5 mg, 10 mg, 15 mg, 30 mg, 60 mg, 100 mg or 200 mg of morphine sulfate.

The other ingredients are:

• Hydroxyethylcellulose
• Cetostearyl alcohol
• Magnesium stearate
• Talc
• Lactose (except for 100 mg and 200 mg tablets)
• Hypromellose (E464) (except for 10 mg)
• Macrogol
• Titanium dioxide (E171)
• Polyvinyl alcohol (10 mg only)

The tablets also contain the following colourants:

10 mg – Iron oxide (E172)

15 mg – Iron oxide (E172), brilliant blue (E133), quinoline yellow (E104) and indigo carmine (E132)

30 mg – Erythrosine (E127), indigo carmine (E132) and sunset yellow (E110)

60 mg – Erythrosine (E127), quinoline yellow (E104) and sunset yellow (E110)

100 mg – Iron oxide (E172) and indigo carmine (E132)

200 mg – Brilliant blue (E133) and quinoline yellow (E104)

The tablets are marked with NAPP on one side and the strength (e.g. 5 mg, 10 mg etc) on the other. The tablets are coloured as follows: 5 mg – white, 10 mg – golden brown, 15 mg – green, 30 mg – purple, 60 mg – orange, 100 mg – grey, 200 mg – teal green.

In each box there are 60 tablets.