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Author: Admin | 2025-04-28
Contin: Children and Adolescents: Total daily oral morphine dose may be administered either in 2 divided doses daily (every 12 hours) or in 3 divided doses (every 8 hours).Conversion from parenteral morphine or other opioids to controlled/extended release formulations: Substantial interpatient variability exists in relative potency. Therefore, it is safer to underestimate a patient's daily oral morphine requirement and provide breakthrough pain relief with immediate-release morphine than to overestimate requirements. Consider the parenteral to oral morphine ratio or other oral or parenteral opioids to oral morphine conversions.Continuous IV infusion, SubQ continuous infusion: Children and Adolescents: 0.01 to 0.04 mg/kg/hour (10 to 40 mcg/kg/hour) (APA 2012; Friedrichsdorf 2007; Golianu 2000); opioid-tolerate patients may require higher doses; in a small study of terminal pediatric oncology patients (n=8; age range: 3 to 16 years), the median required dose was 0.04 to 0.07 mg/kg/hour (40 to 70 mcg/kg/hour); range: 0.025 to 2.6 mg/kg/hour (Miser 1980); another study evaluating subcutaneous continuous infusion in children with cancer (n=17; age range: 22 months to 22 years) had similar findings; median dose: 0.06 mg/kg/hour (60 mcg/kg/hour); range: 0.025 to 1.79 mg/kg/hour (Miser 1983).Conversion from intermittent IV morphine: Administer the patient's total daily IV morphine dose over 24 hours as a continuous infusion; titrate dose to appropriate effect.Sickle cell disease, acute crisis; opioid naïve patients (APS 1999; NHLBI 2014): Note: Individualize dose; titrate to effect; Infants ≥6 months, Children, and Adolescents:Patient weight Patient weight ≥50 kg: Initial: IV: 5 to 10 mg every 2 to 4 hours.Tetralogy of fallot, hypercyanotic spell (infundibular spasm): Infants and Children: Limited data available: IM, IV, SubQ: 0.1 mg/kg has been used to decrease ventilatory drive and systemic venous return (Hegenbarth 2008).Palliative care, dyspnea management: Limited data available: Children and Adolescents:Inhalation (nebulization; preservative-free injection): Dose should be individualized and is dependent upon patient's previous or current systemic opioid exposure; doses not intended to provide analgesic activity; current systemic analgesia should be continued: Initial dose: Equivalent to patient's 4-hour systemic morphine requirement (eg, IV or oral dose); titrate to effect (Golianu 2000); every 4 to 6 hour administration has been suggested (Cohen 2002). In the only pediatric case report (end-stage CF, age: 10 years, weight: 20 kg), an initial dose of 2.5 mg was used and final dose was 10 mg every 4 to 6 hours (Cohen 2002); from experience in adult patients, an initial dose of 5 mg has been used and reported range 2.5 to 30 mg administered up to every 4 hours (Ferraresi 2005; Shirk 2006).Continuous IV or SubQ infusion (when oral ineffective): Initial: 0.005 mg/kg/hour (5 mcg/kg/hour); titrate for comfort (Garcia-Salido 2015); dosing based on palliative management of terminal infants with spinal muscular atrophy (type 1); intermittent IV maximum doses of 0.4 mg/kg have been reported to control symptoms of dyspnea and pain (di Pede 2018).Oral: 0.1 mg/kg/dose every 4 hours as needed (Garcia-Salido 2015); titrate for comfort; dosing based on palliative management of terminal infants with spinal muscular atrophy (type 1); maximum doses of 0.4 mg/kg have been reported to
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