Morphine Extended-Release 15mg Three Times Daily: Not Recommended
No, you should not give morphine extended-release (ER) 15mg three times a day. Extended-release morphine formulations are designed for either every 12-hour or every 24-hour dosing, not every 8 hours. 1
Standard Dosing Intervals for Extended-Release Morphine
- Extended-release morphine is formulated to provide sustained plasma levels over 12 or 24 hours, depending on the specific product 2, 3
- The standard dosing interval is every 12 hours for most ER formulations, with some newer products designed for once-daily (every 24 hours) administration 1
- There is no advantage to increasing dosing frequency beyond every 12 hours, and doing so defeats the purpose of using an extended-release formulation 1
When More Frequent Dosing Is Needed
- If pain returns consistently before the next scheduled ER dose, the solution is to increase the dose, not increase the frequency 1
- In rare cases where patients truly cannot achieve 12-hour duration of analgesia despite dose increases, administration every 8 hours may be considered, but this represents a failure of the ER formulation and suggests the need for a different approach 1
- Patients requiring more frequent dosing should be managed with immediate-release morphine every 4 hours during titration, then converted to an appropriate ER dose once stabilized 1, 4
Correct Approach to Morphine Dosing
- For dose titration, use immediate-release morphine every 4 hours with the same dose available for breakthrough pain 1, 4
- Once pain is controlled, convert to extended-release morphine every 12 hours by calculating the total daily immediate-release dose 1
- If breakthrough pain occurs on a stable ER regimen, provide immediate-release morphine at one-third of the 12-hourly ER dose (equivalent to the 4-hourly dose) 1
Clinical Pitfall
The most common error is attempting to use ER morphine three times daily instead of properly titrating with immediate-release formulations first. This approach compromises both the pharmacokinetic design of the ER formulation and patient convenience 1, 2. If 15mg every 8 hours is needed (45mg total daily), the correct approach is to give morphine ER 20-30mg every 12 hours instead 1.