Opiates in management of breathlessness in palliative care

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.