Oral Infusion
36. Because A.J. was unable to swallow, he agreed to have a gastrostomy feeding tube placed by a general surgeon. He is now being fed through the tube at a rate of 50 mL/hour. Morphine sulfate solution is added to each feeding bag to deliver 10 mg/hour. He also is receiving amitriptyline (Elavil) 150 mg at bedtime, naproxen suspension 250 mg four times a day (QID), and lorazepam (Ativan) 4 mg three times a day (TID) via the feeding tube. A.J. is reasonably alert and is only slightly uncomfortable. Are there any problems associated with placing A.J.'s morphine in the feeding formula?
No reason exists why morphine cannot be given in this manner. The obvious questions about drug stability, solubility, and binding to proteins in the feeding formula do not appear to present a problem because A.J. has been receiving morphine in this manner for the past several days. The dose of morphine (240 mg/day) is apparently not causing undesirable effects, and A.J. is quite comfortable. Administering morphine as a continuous oral infusion at night while he is sleeping is perhaps the best method to ensure restful, pain-free sleep.
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