MORPHINE immediate-release (MIR) oral

Prescription under medical supervision

Therapeutic action

– Centrally acting opioid analgesic

Indications

– Severe pain

Forms and strengths

– 10 mg immediate-release tablet
– 10 mg/5 ml oral solution, for pediatric use

Dosage

There is no standard dose. The optimal dose is that which provides efficient pain relief to the patient. It is adjusted in relation to the regular assessment of pain intensity and the incidence of adverse effects.

– Day 1:

  • Start with a scheduled treatment (scheduled doses):
    Child over 6 months: 0.15 mg/kg every 4 hours
    Adult: 10 mg every 4 hours
  • Adjust the treatment if pain persists by administering “rescue” doses between the scheduled doses. The rescue doses administered are the same as the scheduled doses.

– Then, adjust scheduled treatment every 24 hours according to the total dose given the day before (i.e. total scheduled doses + total rescue doses).
For example, Day 1, for a dose of 60 mg, i.e. 10 mg every 4 hours:

In this example, the scheduled treatment on Day 2 is 90 mg, i.e. 60 mg (total scheduled doses on Day 1) + 30 mg (total rescue doses on Day 1), i.e. 15 mg every 4 hours.

– Scheduled doses must be administered at regular time intervals and not on demand, even at night, unless the patient is abnormally drowsy (in this event, delay the administration).

– Reduce the dose by half in elderly patients and patients with renal or hepatic impairment.

Duration

– Once the pain is controlled, change to sustained-release morphine.

Contra-indications, adverse effects, precautions

– See sustained-release oral morphine (MSR).

Remarks

– Administer an appropriate laxative (e.g. lactulose) if analgesic treatment continues more than 48 hours.
– The morphine dose in tablets is not suitable for young children. Use oral solution instead. If this is not available, use injectable morphine by the oral route: dilute an ampoule of 10 mg/ml (1 ml) with 9 ml of water to obtain a solution containing 1 mg/ml.
– Morphine is on the list of narcotics: follow national regulations.
– Storage: below 25 °C -