with an open distal end or lateral pores. The administration of broken, chewed or crushed capsules or granules may lead to a rapid release and absorption of a potentially fatal dose of morphine (see section 4.9.).įor patients who cannot swallow the capsules, their contents can be administered directly in semi-solid food (puree, jam, yoghurt) or via gastric or gastrostomy tubes of a diameter of more than 16 F.G. The capsules should not be chewed and should normally be swallowed whole. Therefore the dose should be gradually reduced prior to discontinuation. In such patients, individual dose adjustments are required.Īn abstinence syndrome may be precipitated if opioid administration is suddenly discontinued. Usually such increased requirement is of the order of 100%. Patients receiving Zomorph capsules in place of parenteral morphine should be given a sufficiently increased dosage to compensate for any reduction of the analgesic effect associated with oral administration. Patients previously treated with immediate-release oral morphine should receive the same daily dose of sustained-release capsules, but in two divided doses at 12-hourly intervals. It is recommended that the 200 mg strength is reserved for patients who have already been titrated to a stable analgesic dose using lower strengths of morphine or other opioid preparations. The correct dosage for any individual patient is that which is sufficient to control pain with no, or tolerable, side effects for a full 12 hours. Higher doses should be made, where possible in 30-50% increments as required.
Increasing severity of pain will require an increased dosage of the capsules by prescribing the 10mg, 30mg, 60mg, 100mg and 200mg capsules in various combinations or alone to obtain the desired relief.
Prior to starting treatment with opioids, a discussion should be held with patients to put in place a strategy for ending treatment with morphine in order to minimise the risk of addiction and drug withdrawal syndrome (see section 4.4).Īdults: Recommended dosage is one capsule twice daily, at 12-hourly intervals.Įlderly: As with all narcotics, a reduction in dosage may be advisable in the elderly, as appropriate. The dosage is dependent upon the severity of the pain, the patient's age and previous history of analgesic requirements.
ZOMORPH capsules should be used at 12-hourly intervals.
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