Titrating oral morphine
Case example:
Titrate dose upwards by 30-50% increments to relieve pain or until unacceptable side effects occur. Always check the pain is opioid sensitive. A 65 year old patient with lung cancer and bone metastases is taking MST 40mg bd, movicol and ibuprofen. Over the last week he has required on average 3 doses per 24 hrs of 10mg of oramorph for break through pain in his chest. The oramorph works well for the pain after about ½ hour and he has no adverse effects.
What is the most suitable management plan?
Answer
Increase MST by either 30% - 50% (50 or 60ng BD) or to account for frequent breakthrough doses, he's had an extra 30mg per day making total oral morphine, including MST, 110mg, in practice this would be rounded up to 120mg so that MST 60mg 12 hourly can be given. A breakthrough dose would therefore increase to 120mg/6 = 20mg
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