Why did the morphine dose suddenly increase?
A sudden increase in morphine usually means the team is trying to catch up with pain, breathlessness or another distressing symptom that has changed.
A sudden increase in morphine usually means the team is trying to catch up with pain, breathlessness or another distressing symptom that has changed. It does not automatically mean the medicine is being used to hasten death.
It can still feel alarming. Families may see a bigger number on a medicine chart, a syringe driver, or extra "breakthrough" doses and wonder what has happened. The best next step is to ask what symptom the increase is treating, what effect the team expects, and what side effects to watch for.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Common reasons for an increase
Morphine may be increased because pain has become stronger, more constant, or harder to control. This can happen as illness progresses, after movement, during personal care, because of wounds, or because of pressure from a tumour or another condition.
Morphine may also be increased for breathlessness. Low-dose opioids are used in palliative care to ease the feeling of air hunger. This is different from trying to sedate the person or stop breathing.
Sometimes the dose rises because the person has needed several breakthrough doses. A breakthrough dose is an extra dose for a symptom that breaks through the regular medicine. If those extra doses are needed often, the regular medicine may no longer be enough.
The person may be absorbing medicine differently
Near the end of life, swallowing can become hard. Vomiting, bowel problems, weakness, dry mouth or sleepiness can make tablets and liquids less reliable. If the person cannot swallow safely, the team may change the route, such as using medicine under the skin or through a syringe driver.
The number on the chart may look different when the route changes. Medicines given by mouth and medicines given under the skin are not always measured in the same way. Do not compare numbers without asking the nurse, pharmacist or doctor to explain the conversion.
Bigger does not always mean unsafe
There is no single "normal" morphine dose for every person in palliative care. A person who has never taken opioids may need a much smaller amount than someone who has used opioids for weeks or months. Kidney function, age, frailty, other medicines and the cause of the symptom all matter.
Careful dose changes are usually made step by step, with review. The team should be looking for comfort, alertness where possible, breathing pattern, side effects, and whether the person still has distress.
Questions to ask the team
Useful questions include:
- What symptom is this increase meant to treat?
- Is this a change in dose, route, or both?
- How soon should we see an effect?
- What side effects should we tell you about?
- When should we give breakthrough medicine?
- Who do we call overnight if symptoms do not settle?
If the answer is unclear, ask again. Medicine plans at home should be written in a way carers can follow when they are tired or under pressure.
Do not change the dose yourself
Do not increase, reduce or stop morphine unless the person's own prescriber or palliative care team tells you to. Giving less than prescribed can leave the person in pain or breathless. Giving more than prescribed can cause harm.
If you think the plan is wrong, unsafe or unclear, call the palliative care team, GP, nurse, pharmacist or after-hours service before giving another dose, unless the person is in a life-threatening emergency.
When to get help now
Call the palliative care team or after-hours number urgently if the person remains in pain, breathless or agitated after the written plan has been followed, or if they become much more drowsy, confused, twitchy or hard to wake after a dose change.
Call 000 if the person is not breathing, cannot be woken, has taken or been given a possible overdose, or there is another life-threatening emergency.
You may also want to read
- Does morphine make someone die sooner?
- Can I give breakthrough morphine or other medicines myself?
- How do I know when to give breakthrough medicines at home?
- What does putting someone on a syringe driver mean?