As-required oral opioids for intermittent pain in patients with palliative care needs who do not already take a regular opioid

For management of acute pain, including severe acute pain (which is a medical emergency), see Acute pain in palliative care.

If opioid therapy is indicated, see Choice of opioid for pain in palliative care and Starting an opioid for pain in palliative care for guidance on opioid choice and considerations when starting opioid therapy.

For initial as-required therapy with an immediate-release opioid for intermittent pain in patients with palliative care needs who do not already take regular opioid therapy, or are just starting regular opioid therapy, use:

1morphine immediate-release 2 to 5 mg orally, 1-hourly as required12. For patients who are older, frail or cachectic, use the lower end of the dose range and consider more prolonged intervals between doses. Monitor response and review therapy if 3 or more doses are needed in 24 hours; see Monitoring therapy for breakthrough pain morphine

OR

1oxycodone immediate-release 1 to 3 mg orally, 1-hourly as required3. For patients who are older, frail or cachectic, use the lower end of the dose range and consider more prolonged intervals between doses. Monitor response and review therapy if 3 or more doses are needed in 24 hours; see Monitoring therapy for breakthrough pain. oxycodone

The dosage regimens above specify the maximum dose frequency of oxycodone and morphine, based on the expected time to peak effect of the dose. Individualise the dosage regimen by considering the care setting, and the patient’s pain severity and stability, and goals of care.

For patients who cannot take oral drugs or who have impaired gastric absorption, give an equianalgesic dose of the relevant opioid regimen subcutaneously—see Approximate equianalgesic doses of opioids in palliative care for approximate equianalgesic opioid doses.
1 Use care when selecting and measuring immediate-release morphine liquid formulations; dose errors can lead to opioid toxicity.Return
2 In the event of Ordine (immediate-release morphine) oral liquid discontinuation, alternative products may be accessed under the Therapeutic Goods Administration (TGA) Section 19A. For more information, see the TGA website.Return
3 Use care when measuring the immediate-release oxycodone liquid formulation; dose errors can lead to opioid toxicity.Return