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Morphine is effective by a variety of routes of administration. For patients with cancer, it is most frequently given by the oral route (using either immediate-or controlled-release preparations) or by subcutaneous infusion. These two modes of administration are discussed first; the other routes (intravenous, intramuscular, rectal and spinal).

Immediate-release oral morphine

• Oral morphine is the preparation of choice for patients with moderate or severe pain who are able to take oral medication.

Morphine should be given orally whenever possible as this dispenses with the need for injections and the treatment can be self-administered at home. Morphine is well absorbed when given orally. With repeated doses, approximately one-third of an oral dose is bioavailable, making 30 mg PO equivalent to 10 mg IM.

Immediate-release tablets-Morphine sulphate is available as 30 mg tablets (Anamorph). Given the dosage flexibility of morphine mixture and the availability of longer acting oral preparations, immediate-release morphine tablets have no particular advantages in the management of chronic cancer-related pain.

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