5th January 2024

Morphine Titration

When commencing morphine, the total dose taken in the first 24 hours can be used to calculate the total morphine requirement. Morphine may be titrated using 4-hourly immediate-release preparations or a mixture of modified-release preparations (starting at 2mg – 5mg) with immediate-release opioid breakthrough doses. Choice of medication is dependent on the patient’s preference, co-morbidities, age, severity of pain and their level of monitoring. Morphine should not be up-titrated by more than 33-50% every 24 hours.

Breakthrough doses are one-tenth to one-sixth of the 24-hour dose and can be given every 2-4 hours or up to one hourly if needed. If more than 3 doses are taken in 24 hours, this indicates the need to assess the patient’s pain and consider further up-titrating the dose of morphine or the use of a different analgesic.