Use of Oral Morphine

Morphine

Use of Oral Morphine

32. What oral dose of morphine should be selected for A.J.?

The usual initial dose for morphine is 30 mg orally every 3 hours (Table 8-5), but A.J. has been receiving acetaminophen with oxycodone for an unknown length of time and likely has some degree of opioid tolerance. His response to morphine should be monitored carefully 1 to 2 hours after his initial dose and the dose adjusted appropriately. If A.J. experiences clinical signs of overdose (excessive sedation and somnolence, low respiratory rate), the dose should be decreased; however, if he is still uncomfortable after the 2 hours, an additional 30 mg should be given at once and subsequent doses increased by 10 mg to a total of 40 mg every 3 hours. A.J.'s response should be the primary criterion for determining the dose, and the pharmacokinetics of the drug should determine the dosing interval. Frequent reassessment of A.J.'s pain status and level of consciousness is essential.

 

When the pain has been relieved, the dose of morphine often can be decreased. Ideally, only one clinician should assume responsibility for coordinating frequent monitoring of the patient's level of awareness and pain control. Once the pain has been controlled, single-day dosage adjustment should be sufficient. If the dose is changed, then it should be reassessed within the first 2 hours to prevent unnecessary exposure to pain or adverse effects. Most oral opioids reach maximal analgesic effect within the first 2 hours after administration, but for longer-acting opioid analgesics such as methadone, the patient should be monitored for several days because of potential drug accumulation.

Posted in: General Care,Pain and Its Management