Morphine

SOURCE CONTEXT: UK SPC for Morphine 10 mg/5 ml Oral Solution. Dosage can be increased under medical supervision according to the severity of the pain and the patient's previous history of analgesic requirements. When patients are transferred from other morphine preparations, dosage titration may be appropriate; when the oral solution is used in place of parenteral morphine, a 50% to 100% increase in dosage is usually required to achieve the same level of analgesia. Reductions in dosage may be appropriate in the elderly and in patients with chronic hepatic disease (acute hepatic disease is a contraindication), renal impairment, severe hypothyroidism, adrenocortical insufficiency, prostatic hypertrophy, shock, or where sedation is undesirable. Before initiating treatment, agree a treatment strategy with the patient including treatment duration, treatment goals and a plan for ending treatment, in accordance with pain management guidelines; maintain frequent physician-patient contact to evaluate the need for continued treatment. Should not be used longer than necessary; taper the dose gradually when no longer required, to prevent withdrawal symptoms. In the absence of adequate pain control, consider hyperalgesia, tolerance and progression of underlying disease. Care should be exercised in the first 24 hours post-operatively, in hypothyroidism, and where respiratory function is reduced (kyphoscoliosis, emphysema, cor pulmonale, severe obesity). PAEDIATRIC (flat doses from this SPC, not weight-based - verify against a children's formulary before prescribing): children 13 to 18 years 5-20 mg (2.5-10 ml) every 4 hours, maximum 120 mg per day; children 6 to 12 years 5-10 mg (2.5-5 ml) every 4 hours, maximum 60 mg per day; children 1 to 5 years 5 mg (2.5 ml) every 4 hours, maximum 30 mg per day; children under 1 year not recommended.