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MORPHINE-INITIAL DOSE

Initial dose-The starting dose of oral controlled-release morphine may be estimated from the patient's current opioid medication or by initiating treatment with immediate-release oral morphine mixture.

• For patients not currently receiving opioid drugs and those on treatment with opioids other than morphine, the best method of starting controlled-release morphine is to stabilise the patient on immediate-release oral morphine mixture for one to a few days.

Unrelieved or increased pain at the time of starting controlled-release morphine will necessitate an increase in the calculated dose. In addition, a final 4-hourly dose of morphine mixture (or other previous medication) is given at the same time as the first dose of

controlled-release morphine, as several hours are required for significant plasma levels to be achieved from the controlled-release preparation.

MS Contin is normally given 12-hourly while Kapanol may be given either 12-hourly or

24-hourly. The calculations in Table 10.6 refer to either preparation given 12-hourly. If Kapanol is given on a 24 hour schedule, the total daily dose is the same; for example, Kapanol 20 mg ql2h is equivalent to Kapanol 40 mg q24h.

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