Sustained Release Oral Morphine for Patient with Refractory Dyspnea

 

Patient selection: severe dyspnea that persists despite correction of any contributory factors (anemia, etc)

 

Dose: 20 mg oral morphine sulphate in the morning as a sustained released formulation

 

Benefits:

(1) decreased dyspnea

(2) improved sleep

 

Complications:

(1) nausea and vomiting

(2) sedation (can be modified by using a lower dose or dosing in the evening)

(3) constipation (can be modified by diet, laxatives and methylnaltrexone)

 

The use of a low dose, sustained release preparation avoids respiratory depression and hypercapnia.

 

If the oral route is not available, then parenteral morphine can be used.

 

Alternative opiates include dihydrocodeine and diamorphine.