Opioid Analgesics (pain control)

See local guidance above for choice of opioid and recommended dosing.

Remember to co-prescribe both an antiemetic and a laxative for use when necessary - see local guidance above.

Note: If a patient is having PCA (patient controlled analgesia), ensure that additional opioids including codeine are NOT prescribed as there is an additive effect with increased likelihood of side effects.

Pethidine has occasionally been used off-licence for pyrexia and reactions associated with antibody therapy. There is no robust evidence base in the literature for this usage. In practice it would not just be used for any pyrexia, but for difficult to manage patients with Grade 2 or 3 infusion-related syndrome at a single dose of 25mg IV. It should be a third line option, not used routinely or as a standard. Those requiring it would need to be monitored closely every 15 minutes. If there is a reaction the patient would remain on higher monitoring. Prescription of this should be by a haematology registrar on the haematology wards only. It is not to be prescribed by Junior doctors on general wards.

Morphine sulphate (Actimorph) orodispersible tablets (immediate release)

For primary care: Actimorph is on formulary as green for primary care as an alternative choice to morphine sulphate 10mg/5ml oral solution. See above position statement and appropriate use guidance for morphine sulphate oral solution.

In hospital, the following has been agreed:-

• Morphine orodispersible immediate release (IR) tablets (Actimorph) can be prescribed as second choice of morphine preparation for moderate or severe pain in place of Sevredol or Oramorph (first line choice). 
• It is unlikely that orodispersible morphine (Actimorph) will be required for patients with acute pain in hospital unless it is used in preparation for discharge.
• It is recommended that patients admitted on orodispersible morphine tablets are changed to Oramorph whilst an inpatient.