First line: Morphine remains the drug of choice
1. Gain control of pain
- ‘Immediate’ release morphine (oral solution or tablets) gives greatest flexibility for dose titration.
- Starting dose 2.5mg–10mg four-hourly. In the opioid naïve, elderly or those with renal impairment use smaller doses e.g. 2.5mg four-hourly, with close monitoring.
- Additional P.R.N. doses at the same starting dose may be prescribed up to hourly.
- Review the total daily dose of morphine every 24 hours. Titrate the dose
to achieve pain relief by increasing in 30–50% increments per day.
In patients with less severe pain, or where circumstances dictate, morphine may be initiated as a modified release preparation at the appropriate dose.
Use conversion table to determine the appropriate starting dose