Modified-release oral opioid regimens for background pain in palliative care
Ensure patients starting a modified-release oral opioid have an immediate-release opioid prescribed for breakthrough pain or incident pain.
For initial regular therapy with a modified-release oral opioid for background pain in patients with palliative care needs who have not been taking an opioid, use:
1morphine (12-hour) modified-release 5 to 10 mg orally, twice daily1. Review response after 2 days; see Monitoring analgesic therapy in palliative care. If analgesia is inadequate, increase the dose. For patients who are older, frail or cachectic, use the lower end of the dose range initially and slowly titrate dose. Do not use more than 100 mg daily without specialist advice morphine
OR
1morphine (24-hour) modified-release 10 to 20 mg orally, daily1. Review response after 3 days; see Monitoring analgesic therapy in palliative care. If analgesia is inadequate, increase the dose. For patients who are older, frail or cachectic, use the lower end of the dose range initially and slowly titrate dose. Do not use more than 100 mg daily without specialist advice morphine
OR
1oxycodone modified-release 5 mg orally, twice daily2. Review response after 1 to 2 days; see Monitoring analgesic therapy in palliative care. If analgesia is inadequate, increase the dose. Do not use more than 60 mg daily without specialist advice. oxycodone
For initial regular therapy with a modified-release oral opioid for background pain in patients with palliative care needs who have been taking an opioid (eg immediate-release opioids as-required), calculate the total amount of opioid taken in the previous 24 hours and give that amount as a modified-release opioid; do not include doses taken for incident pain3. Give either the total 24-hour dose once daily (if prescribing a once-daily modified-release formulation), or half the total 24-hour dose twice daily (if prescribing a twice-daily modified-release formulation).