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Opiates in management of breathlessness in palliative care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Opioid drugs

  • can relieve the sensation of breathlessness. This is of most benefit for breathlessness at rest rather than on exertion

  • more evidence of efficacy vs benzodiazepines in relieving breathlessness

  • give as a therapeutic trial - monitor benefits and side effects. Titrate up slowly if required by 30% increments

  • opioid-naïve patients:-
    • explain to the patient that morphine may be useful to relieve the sensation of breathlessness
    • prescribe immediate release oral morphine (e.g Oramorph ® ) 2.5-5mg every 4-6 hours and/or PRN 2 hourly

  • patients on opioids for pain currently:-
    • explain to the patient that morphine may also be useful to relieve the sensation of breathlessness
    • some patients may find a lower opioid dose than their current breakthrough analgesic dose helpful for breathlessness, e.g. 25% of the current PRN breakthrough analgesic dose
  • long acting opioids may be considered for some patients with continuous breathlessness (seek specialist palliative care advice)

  • alternative opioids may be considered in some patients who cannot tolerate morphine (seek specialist palliative care advice)

  • lower doses of morphine (e.g Oramorph ®) 1.25 -2.5mg every 4 -6 hours and/or PRN 2 hourly may be more appropriate in the following patients:-  
    • elderly
    • frail
    • severe lung disease
    • heart failure
    • renal impairment

Reference:

  • West Midlands Palliative Care Physicians (2012). Palliative care - guidelines for the use of drugs in symptom control.

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