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Palliative cancer care - dyspnoea - Management
What morphine dose regimen is recommended?
- If not taking an opioid: start oral morphine 2 mg or 2.5 mg. Most people can take this dose every 4 hours and as required, although people with breathlessness may not need as frequent dosing (e.g. just as required 30 minutes before exercise for dyspnoea on exertion).
- If taking a weak opioid (e.g. codeine): only continue the weak opioid if appropriate. Start oral morphine 2.5 mg to 10 mg every 4 hours and as required (or just as required 30 minutes before exercise for dyspnoea on exertion).
- If taking regular analgesic morphine: increase regular morphine dose by around 30% every 2–3 days until symptoms controlled or adverse effects prevent further dose increases.
- Reassess every 2 days and increase the dose until dyspnoea is controlled without adverse effects and the dose is stable. If regular morphine is needed throughout the day, convert to a modified-release preparation. If only one or two doses are needed each day, continue as-required doses of standard-release morphine.
- If benefit once on a stable dose and no adverse effects, calculate the total dose given over 24 hours (new total daily dose). The new 4-hourly dose is one sixth of this.
In depth
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