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Palliative Medicine
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An assessment of the efficacy and tolerability of a ‘double dose’ of normal-release morphine sulphate at bedtime

Jennifer Todd

Palliative Medicine, Trinity Hospice, Clapham, London

Elizabeth Rees

Palliative Care, Royal Marsden Hospital, Sutton

Bridget Gwilliam

Palliative Care, Royal Marsden Hospital, London

Andrew Davies

Palliative Medicine, Bristol Haematology and Oncology Centre, Bristol

This study was a prospective, randomized, open, crossover study comparing a double dose (DD) of normal-release (NR) morphine at bedtime with a single dose (SD) of NR morphine at bedtime and 4 h later. Twenty patients completed the study. Four patients required breakthrough analgesia during the SD phase of the study, whilst 11 patients required breakthrough analgesia during the DD phase of the study (P=0.016). Moreover, all of the pain scores were worse during the DD phase (overnight pain, P <0.01; morning pain, P<0.01), and some of the opioid-related side effect scores were worse during the DD phase (xerostomia, P=0.033; vivid dreams, P=0.05). This study does not support the European Association for Palliative Care (EAPC) recommendations on the use of a double dose of NR morphine at bedtime.

Key Words: dose response relationship • drug guidelines • morphine

Palliative Medicine, Vol. 16, No. 6, 507-512 (2002)
DOI: 10.1191/0269216302pm591oa
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