What it is and what it is used for

for This medicine has been prescribed for you for the relief of severe pain. It contains morphine, which belongs to a class of medicines called opioids, which are 'pain relievers'. The medicine has been prescribed for you and should not be given to anyone else. Opioids can cause addiction and you may get withdrawal symptoms if you stop taking it suddenly. Your doctor should have explained how long you will be taking it for and when it is appropriate to stop, how to do this safely.

What you need to know before you take it

e Sevredol tablets Do not take Sevredol tablets if:

• you are allergic to morphine or any of the other ingredients of the tablets (see 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 three years of age.

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 Sevredol tablets can also lead to dependence, abuse, and addiction, which may result in lifethreatening 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 Sevredol 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 Sevredol 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 Sevredol tablets). Warnings and precautions Tell your doctor or pharmacist before taking these tablets if you experience any of the following symptoms while taking Sevredol tablets:
• 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 Sevredol 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 or 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 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 adrenals 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.

If you are going to have an operation, please tell the doctor at the hospital that you are taking these tablets. 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 Sevredol 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 Sevredol tablets or other opioids. Stop using Sevredol tablets and seek medical attention immediately, if you notice any of the following symptoms: blistering, widespread scaly skin or pusfilled spots together with fever. Sleep-related breathing disorders Sevredol 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. Other medicines and Sevredol tablets Concomitant use of Sevredol 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 Sevredol together with sedative medicines, the dose 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 dose 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. Sevredol 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);
• other strong analgesics or 'painkillers' (such as buprenorphine, nalbuphine or pentazocine);
• 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 a general anaesthetic. Sevredol tablets and alcohol Drinking alcohol during your treatment with these tablets may make you sleepy. If you are affected, you should avoid drinking alcohol.

Pregnancy and breastfeeding 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 Sevredol 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 Sevredol tablets during pregnancy your baby may become dependent and experience withdrawal symptoms after the birth which may need to be treated. Withdrawal (abstinence) symptoms in babies born to mothers who have used Sevredol tablets in pregnancy may include high-pitched crying, irritability and restlessness, shaking (tremor), feeding difficulties and sweating. Do not take Sevredol tablets while you are breastfeeding as morphine passes into breast milk and will affect your baby. Driving and using machines 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: o The medicine has been prescribed to treat a medical or dental problem and o You have taken it according to the instructions given by the prescriber and in the information provided with the medicine and o 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. Sevredol tablets contain lactose and sunset yellow (E110) These 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 20 mg tablets contain sunset yellow (E110) which may cause allergic reactions.

How to take it

Sevredol tablets Always take the tablets exactly as your doctor has told you. The label on your medicine will tell you how many tablets to take and how often. Check with your doctor or pharmacist if you are not sure. Before starting treatment, and regularly during treatment, your doctor will discuss with you what you may expect from using Sevredol tablets, when and how long you need to take it, when to contact your doctor, and when you need to stop it (see also, If you stop taking Sevredol tablets in this section). They will arrange a plan for stopping treatment. This will outline how to gradually reduce the dose and stop taking the medicine. Swallow your tablets whole with a glass of water.

You must only take the tablets by mouth. The tablets should never be crushed and injected as this may lead to serious side effects, which may be fatal. Adults The usual starting dose is one tablet every 4 hours. Your doctor will decide how many tablets you should take. Children Only the 10 mg and 20 mg strength tablets are suitable for children. Children should not be given the 50 mg tablets. Children 3 to 5 years of age The usual dose is 5 mg every four hours. Children 6 to 12 years of age The usual dose is 5 – 10 mg every four hours. 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. If you take more Sevredol tablets than you should or if someone accidentally swallows your tablets Call your doctor or hospital straight away as you may need emergency treatment in a hospital. 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 forget to take Sevredol tablets If you miss a dose you should take it as soon as you remember and then carry on as before. Do not take two doses within 4 hours. Do not take a double dose to make up for a forgotten tablet. If you stop taking Sevredol tablets 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 have any further questions on the use of this medicine, ask your doctor or pharmacist.

Possible side effects

Like all medicines, these tablets can cause side effects, although not everybody gets them.

Stop using Sevredol tablets and seek medical attention immediately if you notice any of the following symptoms:  Sudden wheeziness, difficulties in breathing, dizziness, swelling of the eyelids, face or lips, rash or itching especially those covering your whole body. These may be signs of a severe allergic reaction.  Severe skin reaction with blistering, widespread scaly skin, pus-filled spots together with fever. This could be a condition called Acute Generalized Exanthematous Pustulosis (AGEP).  You begin to breathe more slowly or weakly than expected. This could be a sign of a condition called respiratory depression. The following other side effects may also occur: Very common (may affect more than 1 in 10 people)

• Feeling sick.
• Constipation (your doctor can prescribe a laxative to overcome this problem). Common (may affect up to 1 in 10 people)
• Loss of appetite, dry mouth, abdominal pain or discomfort.
• Vomiting (being sick). (This should normally wear off after a few days. However, your doctor can prescribe an anti-vomiting medicine if it continues to be a problem).
• Drowsiness (this is most likely when you start taking your tablets or when your dose is increased but should wear off after a few days).
• Dizziness, headache, confusion, difficulty in sleeping.
• A feeling of unusual weakness.
• Generally feeling unwell, tiredness.
• Involuntary muscle contractions.
• Rash or itchy skin.
• Sweating. Uncommon (may affect up to 1 in 100 people)
• Withdrawal symptoms (see section 'Drug Withdrawal').
• Indigestion, changes in taste.
• A condition where the bowel does not work properly (ileus).
• Vertigo, (a feeling of dizziness or 'spinning'), fainting, seizures, fits or convulsions.
• Agitation, mood changes, hallucinations, a feeling of extreme happiness.
• Unusual muscle stiffness.
• Difficulty in breathing (possibly due to fluid on the lungs) or wheezing.
• Tingling or numbness.
• Difficulty in passing urine.
• Low blood pressure, facial flushing (redness of the face).
• Feeling your heart beat (palpitations).
• Swelling of the hands, ankles or feet.
• A raised, itchy rash (hives).
• A worsening in liver function tests (seen in a blood test).
• Blurred vision.
• Muscle spasms. Frequency not known (Frequency cannot be estimated from the available data):
• Sleep apnoea (breathing pauses during sleep)
• Unpleasant or uncomfortable mood, abnormal thoughts.

• • • • • • • • • •

An increased sensitivity to pain. Reduction in size of the pupils in the eye. A fast or slow heartbeat. High blood pressure. Decreased cough reflex. Symptoms associated with inflammation of the pancreas (pancreatitis) and the biliary tract system, e.g. severe upper abdominal pain possibly radiating to the back, nausea, vomiting or fever. Severe pain in the lower abdomen or bladder than may come and go. Absence of menstrual periods, decreased sexual drive, impotence. Withdrawal symptoms in babies born to mothers who have used Sevredol tablets in pregnancy (See section 2 "Pregnancy, breastfeeding and fertility"). Dependence and addiction (see section 'How do I know if I am addicted?').

Drug withdrawal When you stop taking Sevredol tablets you may experience drug withdrawal symptoms, which include restlessness, difficulty sleeping, irritability, agitation, anxiety, feeling your heartbeat (palpitations), increased blood pressure, feeling or being sick, diarrhoea, shaking, shivering or sweating. How do I know if I am addicted? If you notice any of the following signs whilst taking Sevredol 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. Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. 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.

How to store it

Sevredol tablets Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the blister and carton. The expiry date refers to the last day of that month. Do not store your tablets above 30°C. Do not throw away medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

Contents of the pack and other information

What Sevredol tablets contain The active ingredient is morphine sulfate. Each tablet contains 10 mg, 20 mg or 50 mg of morphine sulfate. The other ingredients are:

• Lactose
• Pregelatinised maize starch
• Povidone
• Magnesium stearate
• Talc
• Macrogol
• Hypromellose (E464) (10 mg and 50 mg tablets only)
• Titanium dioxide (E171)
• Polyvinyl alcohol (E1203) (20 mg tablet only) The tablets also contain the following colourants: 10 mg – Brilliant blue (E133) 20 mg – Erythrosine (E127) and sunset yellow (E110) 50 mg – Quinoline yellow (E104), indigo carmine (E132) and iron oxide (E172) What Sevredol tablets look like and the contents of the pack The tablets have a score line on one side. 'IR' and the strength (e.g. 10, 20 etc) are on either side of the score line. The tablets are coloured as follows: 10 mg – blue, 20 mg – pink, 50 mg – pale green. In each box there are 56 tablets. Marketing Authorisation Holder Napp Pharmaceuticals Limited, Cambridge Science Park, Milton Road, Cambridge CB4 0GW, UK. Manufacturer Bard Pharmaceuticals Limited, Cambridge Science Park, Milton Road, Cambridge CB4 0GW, UK. This leaflet is also available in large print, Braille or as an audio CD. To request a copy, please call the RNIB Medicine Information line (free of charge) on: 0800 198 5000 You will need to give details of the product name and reference number. These are as follows: Product name: Sevredol tablets Reference number: 16950/0063 This leaflet was last revised in July 2024. ® Sevredol, NAPP and the NAPP logo are registered trade marks. © 2010 – 2024 Napp Pharmaceuticals Limited.