Adults: 15 mg retard tablet. Adults: a patient with severe pain that weaker opioids (for example dihydrocodeine) have not controlled should normally start on 30 mg every 12 hours. Patients who were on normal release oral morphine should get the same total daily dose as Morphine Sulphate 15 mg tablets, but divided into doses 12 hours apart. As the pain gets worse, the tablet dose will need to go up. Where possible, higher doses should be made in increments of 30 to 50% as required. The right dose for any one patient is the one that controls pain for a full 12 hours with no side effects, or side effects the patient can tolerate. Patients moving from parenteral morphine to Morphine Sulphate 15 mg tablets need a sufficiently increased dose to make up for the weaker analgesic effect of oral use. This increase is usually of the order of 100%, and the dose has to be adjusted for each patient. Children: for severe cancer pain, a starting dose in the range of 0.2 to 0.8 mg morphine per kg bodyweight every 12 hours is recommended. Post-operative pain: Morphine Sulphate 15 mg tablets are not recommended in the first 24 hours after surgery, or until normal bowel function has returned. After that, the following schedule is suggested, at the physician's discretion: (a) Morphine Sulphate 30 mg tablets every 12 hours for patients over 70 kg, (c) Elderly, a lower dose may be advisable, (d) Children, not recommended. Supplemental parenteral morphine can be given if needed, but the total morphine dose must be watched carefully, and the prolonged effect of this prolonged release formulation should be kept in mind.
10 mg tablet. Adults and children over 12 years: the dose of Morphine 10 mg tablet depends on how severe the pain is and what analgesics the patient has needed before. One tablet is taken every four hours, or as the physician directs. If the pain becomes more severe, or the patient develops tolerance to morphine, a higher dose of Morphine 10 mg tablet will be needed for the desired relief. Patients taking morphine orally in place of parenteral morphine need a sufficiently increased dose to make up for the weaker analgesic effect of oral use. This increase is usually of the order of 100%, and the dose has to be adjusted for each patient. Elderly: a lower dose than the adult dose may be advisable. Children 3 to 12 years: 3 to 5 years, 5 mg every 4 hours; 6 to 12 years, 5 to 10 mg every 4 hours.
Oral Solution. Adults: the usual dose is 10 to 20 mg (5 to 10 ml) every 4 hours. Children 13 to 18 years: maximum single dose 5 to 20 mg (2.5 to 10 ml) every 4 hours. Children 6 to 12 years: maximum dose 5 to 10 mg (2.5 to 5 ml) every 4 hours. Children 1 to 5 years: maximum dose 5 mg (2.5 ml) every 4 hours. Children under 1 year: not recommended. The dose can be increased under medical supervision, depending on the severity of the pain and the patient's previous analgesic needs. A lower dose may be appropriate in the elderly, in patients with moderate to severe renal or hepatic impairment, or where sedation is undesirable.
Morphine Sulfate is readily absorbed from the gastrointestinal tract after oral use. Even so, when the Oral Solution (5 mg/5 ml) is used in place of parenteral morphine, a 50% to 100% increase in dose is usually required to get the same level of analgesia.
