Opioids for moderate to severe pain

(refer to morphine information sheet)

• Immediate and modified release oral preparations (ensure correct preparation is prescribed); subcutaneous (SC) injection and in syringe pump for continuous subcutaneous infusion (CSCI).
• Renally excreted, active metabolites – titrate morphine slowly and monitor carefully in stage 1 to 3 Chronic Kidney Disease.
• Use alternative opioids in stage 4 and 5 Chronic Kidney Disease and patients undergoing dialysis to avoid toxicity. Refer to End stage renal disease guideline.
• Consider low doses and slow titration in liver impairment.

• Highly soluble opioid used for SC injection and in a syringe pump (CSCI).
• Use for high-dose SC breakthrough injections (above morphine SC bolus injections of 60mg [2ml]). Powder preparation is soluble in a small volume of water for injections.
• As with morphine, cautious use in renal and liver impairment. Avoid in stage 4 and 5 Chronic Kidney Disease.