If adequate pain relief is not achieved within 1-hour, doses of 1 to 2 mg may be given at intervals sufficient to assess effectiveness Initial dose: 5 mg in the lumbar region may provide satisfactory pain relief for up to 24 hours Maximum Dosing: Opioid Naive: 10 mg/hour Opioid Tolerant: 30 mg/hour, although greater rates may be needed in select patients The following is provided as guidance doses should be individualized: Mean morphine self-administration rate during clinical trials was 1 to 10 mg/hour during clinical trials.
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PATIENT CONTROLLED ANALGESIA (PCA): For use in a compatible infusion device patient must be closely monitored because of the considerable variability in both dose requirements and patient response. Between 3 and 6 mg of oral morphine provides pain relief equivalent to 1 mg of parenteral morphine IMPORTANT NOTE: IM administration is not the recommended route of administration due to its painful administration, wide fluctuations in muscle absorption, 30 to 60-minute lag to peak effect, and rapid fall off of action compared to oral administrationĬONVERSION from Parenteral to Oral Morphine: IM: 10 mg IM every 4 hours as needed to manage pain (based on 70 kg adult) IV: 0.1 mg to 0.2 mg/kg via slow IV injection every 4 hours as needed to manage pain alternatively, 2 to 10 mg IV (based on 70 kg adult) IMPORTANT NOTE: Oral solution is available in 3 concentrations 2 mg/mL, 4 mg/mL, and 20 mg/mL reserve use of 20 mg/mL concentration for patients who are opioid-tolerant
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TITRATION AND MAINTENANCE: Individually titrate to a dose that provides an appropriate balance between pain management and opioid-related adverse reactions IR oral solution: Initial dose: 10 to 20 mg orally every 4 hours as needed to manage pain IR tablets: Initial dose: 15 to 30 mg orally every 4 hours as needed to manage pain Individualize dosing regimen taking into account severity of pain, response to therapy, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse: