Regular morphine regimens for pain in the last days of life

For patients who do not already take a regular opioid, if pain is ongoing or if more than 3 as-required morphine doses are needed in 24 hours, consider starting regular morphine therapy in addition to as-required morphine.

Note: If using regular morphine for pain in the last days of life, also prescribe as-required morphine.

For patients who have been taking as-required morphine for at least 24 hours, calculate the total amount taken in the previous 24 hours and give between half and the full total dose as a daily subcutaneous infusion—seek specialist advice if required.

For patients who have not been taking as-required morphine for at least 24 hours, a suitable starting dose for regular morphine therapy for pain in the last days of life is:

morphine 10 to 15 mg/24 hours by continuous subcutaneous infusion¹. Monitor response². If response is inadequate or more than 3 as-required doses are needed in 24 hours, review therapy (see Increasing the dose of regular opioid therapy and Opioid therapy for breakthrough pain for dosage principles). Seek specialist advice if pain relief is inadequate. morphine

For older, frail or cachectic patients, a lower morphine dose (less than 10 mg/24 hours) may be used in settings with rapid access to additional as-required morphine.

If a continuous subcutaneous infusion of morphine is not possible, use:

morphine 2.5 mg subcutaneously, 4-hourly. Monitor response². If response is inadequate or more than 3 as-required doses are needed in 24 hours, review therapy (see Increasing the dose of regular opioid therapy and Opioid therapy for breakthrough pain for dosage principles). Seek specialist advice if pain relief is inadequate. morphine

For older, frail or cachectic patients, a lower morphine dose (less than 2.5 mg) may be used in settings with rapid access to additional as-required morphine.

For patients who already take an opioid, see Opioid therapy for pain in the last days of life in patients who already take an opioid.

¹ When starting or increasing the dose of a drug administered by a continuous subcutaneous infusion, it may take a few hours for the drug to reach a therapeutic concentration. Consider giving an as-required dose of opioid concurrently if timely pain control is needed.Return

² Sedation score, consciousness level and respiratory rate are unreliable measures of opioid toxicity in the last days of life because of the normal physiological changes that occur as death approaches; see Recognising when death is approaching. If opioid toxicity is a concern, seek specialist palliative care advice.Return