Tuesday, February 24, 2015

Could you suffer complications from prostate treatments you never needed?

Protect yourself with the latest information from Harvard Medical School.
2014 Annual Report on Prostate Diseases
Read More

Four of the scariest words a man can hear are: “You have prostate cancer.” Prostate cancer is the second most commonly diagnosed cancer in American men and the second-leading cause of cancer death.
Sometimes the side effects of treatment, which include erectile dysfunction and incontinence, are worse than the disease.
That's because some prostate cancers found using today's high-tech diagnostic techniques would never have caused any health problems or shortened life. That's one reason many doctors are advising mennot to have a routine blood test for prostate-specific antigen (PSA) to detect early prostate cancer. How do you decide what’s best for your health?
Check out Harvard Medical School’s 2015 Annual Report on Prostate Diseases.
This potentially lifesaving report helps you understand why experts are now saying if you don’t have symptoms, don’t get a PSA test. It brings you the latest news on every major prostate disease, from prostate cancer to benign prostatic enlargement (also called BPH) to acute and chronic prostatitis. Click here to discover:
The prostate medication that increases your risk for cancer
How to lower your risk of BPH by 25%
The improved PSA test that saves 20% of men from needing to have a biopsy
How to lower your risk of prostate cancer by nearly 30%
2 foods that may increase your risk of prostate cancer — and the ones that help prevent it
An effective prostate cancer treatment without risk of erectile dysfunction
5 new medications that can help men with late-stage cancer.
Plus, you’ll get a Special Bonus Section on biomarkers — the future of detecting and treating prostate cancer! You’ll read about a urine-based biomarker that could prevent you from undergoing unnecessary surgery, an FDA-approved test that can help determine if your cancer is high-risk, and even a genetic test that accurately rules out prostate cancer 90% of the time!
Harvard Medical School’s 2015 Annual Report on Prostate Diseases is a must-have for all men and the people who love them. That’s why we’re offering it to you right now at 50% OFF the cover price.

Marc B. Garnick, M.D.
Editor in Chief, 2015 Annual Report on Prostate Diseases
Clinical Professor of Medicine, Harvard Medical School
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Monday, February 23, 2015

Morphine Dosage

The information at is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Pain

The following dosing recommendations can only be considered suggested approaches to what is actually a series of clinical decisions over time in the management of the pain of each individual patient.

Immediate release tablets:
Opioid naive:
Initial dose: 15 to 30 mg orally every 4 hours as needed

Oral solution:
Opioid naive:
Initial dose: 10 to 20 mg orally every 4 hours as needed

-Oral solution: Opioid naive patients should be initiated on 10 mg per 5 mL or 20 mg per 5 mL strengths. Opioid-tolerant patients that have already been titrated to a stable analgesic regimen using lower strengths of morphine may be initiated on the 100 mg per 5 mL (20 mg/mL).

Extended-release oral:
Different extended-release products are not bioequivalent. Conversion from one extended-release product to the same total daily dose of another extended-release product may lead to either excessive sedation at peak or inadequate analgesia at trough. Individual product information should be consulted before prescribing and the dosage should be adjusted to the individual patient.

Opioid naive:
Initial dose: 30 mg orally every 24 hours

Opioid tolerant:
Dose should be taken 1 to 2 times daily depending upon the product prescribed.

10 to 20 mg rectally every 4 hours needed

Initial dose: 10 mg every 4 hours as needed
Dose range: 5 to 20 mg every 4 hours as needed

-For relief of pain and as preanesthetic:
Initial dose: 4 to 10 mg every 4 hours administered slowly over 4 to 5 minutes
Dose range: 5 to 15 mg
Daily dose range: 12 to 120 mg
Alternate dose: 2 to 10 mg/70 kg of body weight
-Acute myocardial infarction:
Initial dose: 4 to 8 mg
Maintenance dose: 2 to 8 mg every 4 to 15 minutes as needed
-Open heart surgery: 0.5 to 3 mg/kg IV as the sole anesthetic or with an anesthetic agent
-Severe chronic pain associated with terminal cancer:
Continuous IV Infusion: Prior to initiation of the infusion (in concentrations between 0.2 to 1 mg/mL), a loading dose of 15 mg or higher of morphine sulfate may be administered by IV push to alleviate pain.
-IV patient controlled analgesia or subcutaneous patient controlled analgesia:
1 to 2 mg injected 30 minutes after a standard IV dose of 5 to 20 mg. The lockout period is 6 to 15 minutes.

Initial dose: 5 mg in the lumbar region may provide satisfactory pain relief for up to 24 hours. If adequate pain relief is not achieved within one hour, careful administration of incremental doses of 1 to 2 mg at intervals sufficient to assess effectiveness may be given.
Maximum dose: 10 mg per 24 hr

-Dosage is usually one-tenth that of epidural dosage
-Initial dose: 0.2 to 1 mg may provide satisfactory pain relief for up to 24 hours. Repeated intrathecal injections are not recommended.

Usual Pediatric Dose for Pain

-The following dosing recommendations can only be considered suggested approaches to what is actually a series of clinical decisions over time in the management of the pain of each individual patient.
-Safety and efficacy of this drug in neonates have not been established. Opiate agonists should not be used in premature neonates since the drugs cross the immature blood-brain barrier more readily than in the mature barrier producing disproportionate respiratory depression. Opiates should be administered with caution and in monitored dosages to infants and small children since they may be relatively more sensitive to opiates on a body weight basis.

-Subcutaneous: 0.1 to 0.2 mg per kg as needed. Not to exceed 15 mg per dose.
-IV: 50 to 100 mcg (0.05 to 0.1 mg) per kg, administered very slowly. Not to exceed 10 mg per dose.

Renal Dose Adjustments

End-stage renal disease: Start at the lower suggested dosage for the indication and the patient needs; titrate dosage upwards slowly and increase the dosage intervals to prevent accumulation of the metabolite morphine-6-glucoronide.

Liver Dose Adjustments

Caution is recommended. Dosage reductions should be considered.

Dose Adjustments

The dosing regimen of this drug should be adjusted for each patient individually, taking into account prior analgesic treatment experience. In the selection of the initial dose consider the following:
-Different formulations of this drug are not bioequivalent. When switching a patient from one form to another, consult the product labeling or local protocol.
-The total daily dose and potency of the opioid the patient took previously.
-The degree of opioid tolerance of the patient
-The general condition and medical status of the patient
-Concurrent medications
-Type and severity of the pain
-Risk factors for abuse, addiction, or diversion, including a prior history of abuse, addiction, or diversion.

-As needed "rescue doses" of immediate release oral formulations may be needed for patients with cancer pain. The need for more than 2 rescue doses per day may require a review of the controlled release dose.
-The parenteral morphine tartrate and sulfate salt formulations contain almost an equivalent amount of morphine base per milligram, and may be used interchangeably.
-Morphine sulfate controlled release oral formulations have not been shown to be bioequivalent; adjustment between these formulations should be done with caution and careful titration.
-This drug should be used with caution in patients greater than 50 years of age, debilitated patients, and patients with impaired respiratory function; doses may need to be reduced by up to half of the usual daily adult dose.
-Titrate dosage slowly upward, taking into consideration the dosages received for breakthrough pain, to meet the specific needs of the patient.
-Factors such as age, disease state, concomitant drug therapy, analgesic history, and tolerance to narcotics can have variable but important effects on dose and response. In some patients with severe, chronic pain, it may be necessary to exceed the usual dose. Doses should be maintained at the lowest effective dose.
-Dosage reductions may be required with concomitant CNS depressant therapy.
-Patients may initially experience drowsiness or increased sedation due to exhaustion that may be mistaken as excessive analgesia. Initial doses should be maintained for at least 3 days before any dose reduction, as long as sedation is not excessive or associated with unsteadiness, and confusion, and that respiratory activity and other vital signs are adequate.
-The daily dose should be gradually tapered to minimize or prevent withdrawal symptoms.
-Caution and reduced doses are recommended with concomitant use of other narcotic analgesics, general anesthetics, phenothiazines, and other tranquillizers, sedatives/hypnotics, tricyclic antidepressants, and other CNS depressants, including alcohol.
-Continual reevaluation of the patient receiving this drug is important, with special attention to the maintenance of pain control and the relative incidence of side effects associated with therapy. During chronic therapy, especially for non-cancer related pain, the continued need for the use of opioid analgesics should be periodically reassessed.


The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for extended-release and long-acting opioid analgesics. The REMS consists of a medication guide and elements to assure safe use. Additional information is available at

ADDICTION/ABUSE/MISUSE: This drug exposes users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Addiction can occur at recommended doses, and if the drug is misused or abused. These risks are particularly important for extended release formulations. Accidental ingestion of this drug by children or pets can result in a fatal overdose.
-Each patient should be assessed for risks prior to prescribing, and monitored regularly for the development of these risks.
-Patients should be instructed to swallow extended release dose units whole. They should not be chewed, crushed, or dissolved to avoid rapid release of a potentially fatal dose. Some individual formulations may be opened and mixed with applesauce and consumed immediately; consult product labeling.
-Patients should be instructed to keep this medication out of the reach of children and pets.
ALCOHOL: Patients should be instructed to avoid alcohol ingestion while taking this drug. Concomitant use of this drug with alcohol can cause fatal plasma levels of drug.
PREGNANCY: Prolonged use of this drug during pregnancy can result in withdrawal signs (e.g., irritability, hyperactivity and abnormal sleep pattern, high pitched cry, tremor, vomiting, diarrhea, failure to gain weight) in the neonate, which, unlike opioid withdrawal in adults, may be life-threatening if not recognized and treated, and requires management by neonatology experts.
Recommendation: If opioid use is required for a prolonged period in a pregnant woman, the patient should be advised of the risk to the neonate.

Serious adverse events and deaths have resulted from accidental overdose of this drug in oral solution form. In most of these cases, the oral solutions ordered in milligrams (mg) were mistakenly interchanged for milliliters (mL) of the product. When this occurs with a high concentration oral solution, the result can be up to a 20 fold overdose. Healthcare providers should read the instructions in the Medication Guide that describe the correct use of the oral syringe in order to help prevent medication errors.

This drug, particularly in large doses or when administered by parenteral routes, may cause life-threatening respiratory depression. Treatment includes maintenance of the airway, artificial ventilation if necessary, and the opiate antagonist, naloxone (the usual adult dose of naloxone is 1 to 2 mg every 5 minutes as necessary, or consult local protocol). This dose can be administered IV, IM, or subcutaneously.

This drug should be administered with caution to patients with head injuries, increased intracranial pressure, acute undiagnosed abdominal pain, hypothyroidism, severe renal disease, severe liver disease, Addison's disease, prostatic hyperplasia, urethral stricture, and general debilitation. Even small doses may jeopardize cerebral circulation in the postoperative period following craniotomy.

Safety and efficacy have not been established neonates. Consult product labeling for pediatric warnings for individual dosage forms.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule II


Data not available

Other Comments

Administration advice:
-This drug should be prescribed only by healthcare professionals knowledgeable in the use of potent opioids for the management of chronic pain.
-Patients should not consume alcoholic beverages while on morphine.
-When this drug is administered intravenously, an opiate antagonist and facilities for administration of oxygen and control of respiration should be available.
-This drug has been reported to be physically or chemically incompatible with various drug products. Specialized references should be consulted for specific compatibility information.
-Dose should be titrated based upon individual response to the initial dose.
-Extended-release capsules should be taken whole, not crushed, chewed, or dissolved. Patients unable to swallow the capsules may sprinkle the capsule contents on applesauce and immediately swallow without chewing.
- Patients considered opioid tolerant are those taking, for 1 week or longer, at least 60 mg of morphine daily, at least 30 mg of oral oxycodone daily, at least 8 mg of oral hydromorphone daily, or an equianalgesic dose of another opioid.
-The extended-release formulations should not be used for breakthrough pain or on an as needed basis.
-Use only the preservative free injectable formulations for preparations given via the epidural and intrathecal routes, and in neonates.
-Immediate-release tablets: The 10 and 20 mg tablets are not recommended for children under 3 years. The 50 mg tablets are not recommended for children.

Patient advice:
-Side effects associated with opioids, apart from constipation, generally reduce with time. Anticipation and management of these effects may improve tolerability. Patients taking this drug may require an antiemetic during early therapy.