Morphine regimens for anticipatory prescribing or intermittent pain in the last days of life
Morphine is the opioid of choice in the last days of life, even in patients with some degree of kidney or liver impairment—see Overview of opioid use in palliative care for an overview of opioid prescribing considerations. If morphine is contraindicated (eg true allergy [which is rare], severe kidney impairment), use an equivalent dose of an alternative opioid at an appropriate dose interval (see Approximate equianalgesic doses of opioids in palliative care for equianalgesic doses)—seek specialist advice if needed.
For patients who do not already take an opioid, a suitable starting dose of as-required morphine for anticipatory prescribing or intermittent pain in the last days of life is:
morphine 2.5 to 5 mg subcutaneously, 1-hourly as required. Monitor response and seek specialist advice if pain relief is inadequate1. If more than 3 doses are needed in 24 hours, consider starting (or increasing the dose of) regular morphine therapy. morphine
For older, frail or cachectic patients, a lower dose of morphine (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 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