THE USE OF MORPHINE BY MOUTH IN ADVANCED CANCER

  • 1 January 1983
    • journal article
    • research article
    • Vol. 32  (6) , 279-283
Abstract
Oral morphine sulfate is the strong narcotic of choice at most hospices. It is administered in simple aqueous solution (e.g., 10 mg in 10 ml). There is no advantage in administering it as a Brompton Cocktail. The usual starting dose is 10 mg every 4 h. If the patient previously only had a weak narcotic analgesic, 5 mg may be adequate. If changing to morphine from an alternative strong narcotic, such as dextromoramide, levorphanol or methadone, a considerably higher dose may be needed. With frail elderly patients, it may be wise to start on a sub-optimal dose in order to reduce the possibility of initial drowsiness and unsteadiness. Adjust upwards after 1st dose if not more effective than previous medication. Adjust after 24 h if pain not 90% controlled. Most patients are satisfactorily controlled on a dose of 5-30 mg every 4 h; however, some patients need higher doses, occasionally up to 500 mg. Giving a larger dose at bedtime (1.5 or 2 .times. daytime dose) may enable a patient to go through the night without waking in pain. Use co-analgesic medication as appropriate. Either prescribe an antiemetic concurrently or supply (in anticipation) for regular use should nausea or vomiting develop. Prescribe a laxative. Adjust dose according to response. Suppositories may be necessary. Unless carefully monitored, constipation may be more difficult to control than the pain. Write out regimen in detail with times to be taken, names of drugs and amount to be taken. Warn patient of possibility of initial drowsiness. Arrange for close liaison and follow up.