Morphine

Indications & Dose:

INDICATIONS AND DOSE

Pain

 BY SUBCUTANEOUS INJECTION Child 1–5 months:

Initially 100–200 micrograms/ kg every 6 hours, adjusted according to response Child 6 months–1 year: Initially 100–200 micrograms/kg every 4 hours, adjusted according to response Child 2–11 years: Initially 200 micrograms/kg every 4 hours, adjusted according to response Child 12–17 years: Initially 2.5–10 mg every 4 hours, adjusted according to response

INITIALLY BY INTRAVENOUS INJECTION Child 1–5 months:

100 micrograms/kg every 6 hours, adjusted according to response, dose to be administered over at least 5 minutes, alternatively (by intravenous injection) initially 100 micrograms/ kg, dose to be administered over at least 5 minutes, followed by (by continuous intravenous infusion) 10–30 micrograms/kg/hour, adjusted according to response Child 6 months–11 years: 100 micrograms/kg every 4 hours, adjusted according to response, dose to be administered over at least 5 minutes, alternatively (by intravenous injection) initially 100 micrograms/kg, dose to be administered over at least 5 minutes, followed by

(by continuous intravenous infusion) 20–30 micrograms/kg/hour, adjusted according to response Child 12–17 years: 5 mg every 4 hours, adjusted according to response, dose to be administered over at least 5 minutes, alternatively (by intravenous injection) initially 5 mg, dose to be administered over at least 5 minutes, followed by (by continuous intravenous infusion) 20–30 micrograms/kg/hour, adjusted according to response

BY MOUTH, OR BY RECTUM Child 1–2 months: Initially 50–100 micrograms/kg every 4 hours, adjusted according to response Child 3–5 months: 100–150 micrograms/kg every 4 hours, adjusted according to response Child 6–11 months: 200 micrograms/kg every 4 hours, adjusted according to response Child 1 year: Initially 200–300 micrograms/kg every 4 hours, adjusted according to response Child 2–11 years: Initially 200–300 micrograms/ kg every 4 hours (max. per dose 10 mg), adjusted according to response Child 12–17 years: Initially 5–10 mg every 4 hours, adjusted according to response Acute pain

 BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION Adult: Initially 10 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration, use dose for elderly in frail patients Elderly: Initially 5 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration

BY SLOW INTRAVENOUS INJECTION Adult: Initially 5 mg every 4 hours, adjusted according to response, dose can be adjusted more frequently during titration, reduced dose recommended in frail and elderly patients Chronic pain

 BY MOUTH,

OR BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION Adult: Initially 5–10 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients

  BY RECTUM Adult: Initially 15–30 mg every 4 hours, adjusted according to response Pain (with modified-release 12-hourly preparations)

 BY MOUTH USING MODIFIED-RELEASE MEDICINES Adult:

Every 12 hours, dose adjusted according to daily morphine requirements, dosage requirements should be reviewed if the brand is altered Pain (with modified-release 24-hourly preparations) BY MOUTH USING MODIFIED-RELEASE MEDICINES Adult: Every 24 hours, dose adjusted according to daily morphine requirements, dosage requirements should be reviewed if the brand is altered Pain management in palliative care (starting dose for opioid-naïve patients)

  BY MOUTH Adult: 20–30 mg daily in divided doses, using immediate-release preparation 4-hourly or a 12hourly modified-release preparation, for management of breakthrough pain and other general advice, see Pain management with opioids p. 22. Pain management in palliative care (starting dose for patients being switched from a regular weak opioid)

 BY MOUTH Adult: 40–60 mg daily in divided doses, using immediate-release preparation 4-hourly or 12hourly modified-release preparation, for management of breakthrough pain and other general advice, see Pain in palliative care (following initial titration)

 BY MOUTH USING IMMEDIATE-RELEASE MEDICINES Adult: Usual dose 30 mg every 4 hours; up to 200 mg every 4 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids p. 22.

 BY MOUTH

USING MODIFIED-RELEASE MEDICINES Adult: Usual dose 100 mg every 12 hours; up to 600 mg every 12 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice. Cough in terminal disease

 BY MOUTH Adult: Initially 5 mg every 4 hours Premedication

BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION Adult: Up to 10 mg, dose to be administered 60– 90 minutes before operation Patient controlled analgesia (PCA)

 BY INTRAVENOUS INFUSION Adult: (consult local protocol) Myocardial infarction

BY SLOW INTRAVENOUS INJECTION Adult: 5–10 mg, followed by 5–10 mg if required, dose to be administered at a rate of 1–2 mg/minute, use dose for elderly in frail patients Elderly: 2.5–5 mg, followed by 2.5–5 mg if required, dose to be administered at a rate of 1–2 mg/minute Acute pulmonary oedema

 BY SLOW INTRAVENOUS INJECTION Adult: 5–10 mg, dose to be administered at a rate

of 2 mg/minute, use dose for elderly in frail patients Elderly: 2.5–5 mg, dose to be administered at a rate of 2 mg/minute Dyspnoea at rest in palliative care

  BY MOUTH Adult: Initially 5 mg every 4 hours, to be given in carefully titrated doses 

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