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Inconsistent morphine prescribing guidelines

Taubert, Mark 2009. Inconsistent morphine prescribing guidelines. Presented at: 11th Congress of the European Association for Palliative Care 2009, Vienna, Austria, 7-10 May 2009. -.

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We reviewed fifteen sources that include guidance on opioid prescribing and found marked variations. Some made little or no mention of starting doses, titration advice or advice on upper limits Starting doses for opioid-naïve patients vary from 6-60 mg per 24 hours Titration advice varies from increasing dose by 30% every 2-3 days to 50% for hours after previous dose. Suggested upper limits for oral morphine vary from 300mg/24 hours to 3000mg/24 hours to statements that there is no maximum dose Possible think-list for morphine prescribing (it all may seem obvious but there is a lack of consensus): What is the starting dose for oral morphine? • Opioid-naïve (e.g. on paracetamol only): 2.5mg instant release four hourly or 5mg controlled release twelve hourly • On previous opioids (e.g. codeine, buprenorphine etc): add up total daily dose and convert to equivalent oral morphine dose then give in divided doses(four hourly for instant release, twelve hourly for controlled release) What about pain between doses? Give the equivalent of the four-hourly dose in between regular doses. In severe pain patients may need more than one extra dose How should morphine be titrated? • Amount of titration: increase in 30-50% steps. Often this is done by adding the total amount of opioid taken in the previous 24 hours (regular doses plus extra doses) and using that to guide the subsequent increment of the patient’s regular dose • Titration intervals: wait for at least 5 times the half life of the drug (for morphine this is at least 24 hours). More frequent dose increases are possible for severe pain but immediate-release morphine should be used to get on top of the pain and b)monitor for adverse effects What is the median dose of opioid that the terminally ill usually need? • The median daily dose of oral morphine is 90mg/24 hours, or 15mg four hourly

Item Type: Conference or Workshop Item (Poster)
Status: Published
Schools: Medicine
Date of Acceptance: 2009
Last Modified: 25 Jan 2019 11:15

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