Are there slow-release morphine (opioid analgesic) options available for a 93-year-old female cancer patient currently receiving 5 milligrams (mg) of liquid morphine (opioid analgesic) every six hours?

Slow-Release Morphine Options for Elderly Cancer Patient

Yes, slow-release (modified-release) morphine formulations are available and would be appropriate for this 93-year-old female cancer patient currently receiving 5 mg of liquid morphine every six hours. 1

Conversion to Modified-Release Morphine

Dosing Calculation

• Current regimen: 5 mg liquid morphine every 6 hours = 20 mg total daily dose
• Appropriate modified-release conversion:
  • 10 mg modified-release morphine every 12 hours 1
  • OR 20 mg modified-release morphine once daily (24-hour formulation) 1

Available Formulations

• 12-hour formulations: tablets, capsules, or liquids 1
• 24-hour formulations: tablets 1
• Various tablet strengths available: 15 mg, 30 mg, 60 mg, and 100 mg 2

Benefits of Modified-Release Morphine for This Patient

1. Improved pain control: Provides more consistent analgesia with fewer pain fluctuations 1, 3
2. Better sleep quality: Avoids nighttime awakening for medication 1
3. Simplified regimen: Reduces dosing frequency from four times daily to once or twice daily 1
4. Improved adherence: Especially important in elderly patients 4
5. Reduced risk of dosing errors: Particularly relevant for elderly patients 5

Implementation Plan

1. Initial conversion:

   • Start with 10 mg modified-release morphine every 12 hours 1, 4
   • For elderly patients (>70 years), consider starting at a lower dose (e.g., 5 mg every 12 hours) 6

2. Breakthrough pain management:

   • Provide immediate-release morphine liquid as rescue medication 1
   • Rescue dose should be 10-20% of total daily dose (2-4 mg) 1
   • Allow rescue doses as needed 1

3. Dose titration:

   • Review pain control after 48 hours 1
   • If patient requires frequent breakthrough doses, increase the modified-release dose accordingly 1
   • Adjust by adding the total daily rescue dose to the regular modified-release dose 1

Important Considerations for Elderly Patients

• Start low, go slow: Elderly patients may have altered pharmacokinetics 4, 5
• Monitor closely: Watch for respiratory depression, excessive sedation, and confusion 5
• Constipation prevention: Always prescribe a prophylactic laxative regimen 1, 4
• Renal function: Monitor renal function as morphine metabolites can accumulate 4, 5
• Avoid rapid dose escalation: Increase doses by no more than 25% at a time in elderly patients 5

Potential Pitfalls and How to Avoid Them

1. Respiratory depression: Monitor respiratory rate and sedation level, especially in the first few days 4, 5
2. Constipation: Implement prophylactic bowel regimen from the start 1, 4
3. Cognitive effects: Assess for confusion or excessive sedation 5
4. Inadequate breakthrough pain control: Ensure appropriate rescue dose is available 1
5. Withdrawal symptoms if converting improperly: Follow proper conversion protocols 5

Modified-release morphine has been shown to be as effective as immediate-release formulations while providing more consistent pain control and improved quality of life for cancer patients 3, 7, 8. For this elderly patient, the switch to a modified-release formulation would likely improve pain management while simplifying her medication regimen.