Morphine/ Cyclizine

Registered South African indications:

• Pain 

Contraindications

• Hypersensitivity to the active ingredient or any of the excipients in this combination product
• Respiratory depression, especially in the presence of cyanosis and excessive bronchial secretions as morphine diminishes the cough response
• Patients experiencing an attack of bronchial asthma, or heart failure secondary to chronic lung disease
• The presence of acute alcoholism, head injury and raised intracranial pressure
• Coadministration with monoamine oxidase inhibitors or within 14 days of stopping such treatment
• Ulcerative colitis, since it may precipitate toxic dilation or spasm of the colon
• Paralytic ileus and delayed gastric emptying
• Moderate or severe renal impairment (GFR < 20ml/min)
• Severe hepatic impairment as it may precipitate hepatic encephalopathy or coma
• At the recommended dosages, morphine/ cyclizine is contraindicated in biliary and renal tract spasm, and in patients immediately after operative interventions in the biliary tract
• Pregnancy
• Lactation
• Presence of acute alcohol intoxication

Cautions

• Mild renal impairment
• Mild to moderate hepatic impairment
• Elderly 
• Abrupt withdrawal 
• Debilitated patients 
• Seizure disorders
• Delerium tremens
• Severe cor pulmonale
• Hypothyroidism
• Adrenocortical insufficiency
• Hypopituitarism
• Prostatic hypertrophy
• Shock
• Diabetes mellitus
• Myasthenia gravis
• Hypotension
• Hypovolaemia
• Pancreatitis
• Obstructive gastrointestinal disorders
• Inflammatory bowel disorders
• Phaeochromocytoma
• Severe cardiac failure
• Porphyria
• Intravenous cyclizine
• Underlying neuromuscular disorders
• Glaucoma 
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: inj

Pain - moderate to severe
- In all suitable medical and surgical conditions in which reduction of the nausea and vomiting associated with the administration of morphine is required

Morphine/ Cyclizine
10/50 (mg/ml)
15/50 (mg/ml)

• SC/IM: 1ml, 4hrly; Max: 3 doses/24hrs 

Not established for use in children below 12 years

Pregnancy

• Contraindicated

Breastfeeding

• Contraindicated

Renal Impairment

• Mild: Caution; no information available
• Moderate or severe renal impairment (GFR < 20ml/min): Contraindicated

Hepatic Impairment

• Mild: Caution; no information available
• Severe: Contraindicated

 Elderly

• Caution; dose adjustment recommended

Porphyria Information

• Not yet classified (NC)

Drugs in Sport

• Prohibited - In competition

Central Nervous System Disorders

• Increased intracranial pressure
• Drowsiness
• Confusion
• Restlessness
• Vertigo
• Sedation
• Headache
• Nervousness
• Insomnia
• Auditory and visual hallucinations
• Dystonia
• Dyskinesia
• Extrapyramidal motor disturbances
• Tremor
• Twitching
• Seizures 
• Disorientation
• Dizziness
• Decreased consciousness
• Transient speech disorders
• Paraesthesia
• Generalised chorea
• Dysphoria
• Psychomotor hyperactivity
• Paralysis
• Overdose 

Cardiovascular Disorders

• Tachycardia
• Orthostatic hypotension
• Hypertension

Respiratory Disorders

• Respiratory depression
• Bronchospasm
• Apnoea
• Paroxysmal cough

Gastrointestinal Disorders

• Constipation
• Nausea and vomiting
• Dry mouth, nose and throat

Hepatobiliary Disorders

• Biliary tract spasm
• Cholestatic jaundice
• Cholestatic hepatitis
• Hypersensitivity hepatitis
• Hepatic dysfunction

Genitourinary Disorders

• Renal spasm
• Dysuria 
• Urinary retention

Endocrine and Metabolic Disorders

• Decreased testosterone

Skin and Subcutaneous Tissue Disorders

• Injection site reactions
• Allergic skin reactions
• Rash 

Immune, Blood and Lymphatic System Disorders

• Agranulocytosis
• Thrombocytopenia
• Hypersensitivity reactions

Sensory Disorders

• Miosis
• Blurred vision 

• Phenothiazines
• Hypnotics
• Neuroleptics
• Alcohol
• Muscle relaxants
• Mexilitine 
• Metoclopramide
• Monoamine oxidase inhibitors
• Cimetidine
• Anticholinergic agents
• Dexamfetamine
• Hydroxyzine
• Diuretics
• Propranolol
• St. John's wort
• Ritonavir
• Folin-Ciocalteau reagent

None routine. Specific cases may require

• Renal function
• Hepatic function
• Respiratory function
• Intraocular pressure 

Morphine
Morphine is a potent analgesic with competitive agonist actions at opioid receptors, predominantly the mu receptor.

Cyclizine
Cyclizine is a histamine H1 receptor antagonist. It possesses anticholinergic and antiemetic properties. The chemotrigger zone possesses neurons which are rich in muscarinic cholinergic and histamine receptor containing synapses. These types of neurons are involved in the transmission of impulses from the vestibular apparatus to the vomiting centre.  Cyclizine reduces activity along these pathways.

COMBINATION PREPARATIONS

Cyclizine/ Morphine

Injection (per ml) 50mg/10mg 

• Cyclimorph (Pharmacare) originator

Injection (per ml) 50mg/15mg 

• Cyclimorph (Pharmacare) originator