Initiating morphine
• Reassure the patient about the safety and efficacy of opioids
• Prescribe a laxative and antiemetic
• For opioid naive patients:
	– 2.5–5.0 mg of morphine elixir/immediate release tablet 4 hourly + equal dose to be taken PRN between regular doses if pain is not controlled
	– if pain is not controlled, increase each dose by 25–50%
	– when dosing is stable with good pain control, convert daily dose to a once or twice daily slow release preparation
• review daily during the titration phase (this can be done by phone)
Calculating breakthrough doses
• Traditionally 1/6 of the total daily opioid requirement has been used for PRN dosing. This does give an idea of the starting dose, which can be adjusted according to effect. Some patients will need smaller doses, some larger
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