Diamorphine is usually used as the first line injectable strong opioid as it is more water soluble than morphine. Morphine sulphate injection should be used as alternative first line injectable strong opioid if diamorphine is not available.
Approximate equivalent doses of oral morphine and subcutaneous morphine and diamorphine
Diamorphine is usually given with anti-emetics, sedatives, or hyoscine.
Ensure that appropriate analgesia is available for breakthrough pain (oral, rectal or parenteral).
Equivalent doses to morphine are shown in the table below:
4-hourly oral morphine dose (mg) | Total daily dose of oral morphine (mg/24hour) | Subcutaneous morphine (mg/24hour) | Subcutaneous diamorphine (mg/24hour) | Dose of SC diamorphine for breakthrough pain (mg) | Dose of SC morphine for breakthrough pain (mg) |
15 | 90 | 45 | 30 | 5 | 5 |
30 | 180 | 90 | 60 | 10 | 15 |
40 | 240 | 120 | 80 | 15 | 20 |
Reference:
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