Oral Morphine

Vignette:

A 60 year old gentleman was experiencing significant pain. In our practice, subcutaneous infusions are not used in the home setting and the nurses have only oral morphine concentrate for pain medication. How can we rapidly titrate oral morphine to determine appropriate dose of medication for palliation of pain?

Discussion:

Oral morphine reaches maximum concentration (Cmax) in one hour and has a half life of four hours. For rapid titration morphine can be given hourly in escalating doses. For example, morphine 5 mg may be given orally. In one hour, if patient is still in pain, morphine 10 mg may be given. In another hour, if patient is still in pain, morphine 20 mg can be given. When pain is palliated, add the total amount of morphine needed to make patient comfortable and divide in half. If the patient received 35 mg in 4 hours, he would require 17.5 mg every 4 hours as a baseline because the half life is 4 hours and half the medication would need to be replaced. Careful monitoring and assessment of patient's pain is necessary throughout this process.

"It was so helpful to talk with someone who is comfortable with specific uses of medications in the palliative medicine setting and the information will positively impact our patient care." –Pharmacist

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