BNF for Children 2011-2012

BNFC 2011–2012 Prescribing in palliative care 21Equivalent doses of morphine sulphate anddiamorphine hydrochloride given over 24hoursThese equivalences are approximate only and mayneed to be adjusted according to responseOralmorphinesulphateMORPHINESubcutaneousinfusion ofmorphine sulphatePARENTERALDIAMORPHINESubcutaneousinfusion ofdiamorphinehydrochlorideover 24 hours over 24 hours over 24 hours30 mg 15 mg 10 mg60 mg 30 mg 20 mg90 mg 45 mg 30 mg120 mg 60 mg 40 mg180 mg 90 mg 60 mg240 mg 120 mg 80 mg360 mg 180 mg 120 mg480 mg 240 mg 160 mg600 mg 300 mg 200 mg780 mg 390 mg 260 mg960 mg 480 mg 320 mg1200 mg 600 mg 400 mgIf breakthrough pain occurs give a subcutaneousinjection equivalent to one-tenth to one-sixth of thetotal 24-hour subcutaneous infusion dose. With anintermittent subcutaneous injection absorption issmoother so that the risk of adverse effects at peakabsorption is avoided (an even better method is to usea subcutaneous butterfly needle).To minimise the risk of infection no subcutaneousinfusion solution should be used for longer than 24hours.Prescribing in palliative care