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Dyspnea in the palliative phase

Based on the available evidence, morphine remains the drug of choice for dyspnea in the palliative phase. While it is plausible that other opioids such as oxycodone and fentanyl also have effectiveness, there is little evidence for this to date. The medical advice is to start with slow release morphine 2 dd 10 mg per os. An alternative is to start with immediate release morphine 2.5 mg as needed or 6 dd 2.5-5 mg per os.

If the route of oral administration is not possible, or if a rapid effect is desired, start with 2.5 mg morphine sc/iv if necessary or 6 dd 2.5 mg morphine sc/iv. An alternative in this case is continuous administration of 15 mg/24 hours sc/iv.

If a patient is already taking another opioid, it is preferable to rotate to morphine at  equi-analgesic dose or with a dose increase of 25-50%.

If morphine does not have sufficient effect, especially if anxiety and tension seem to play a role, consider adding a benzodiazepine. Also, depending on the cause of the dyspnea, consider adding a corticosteroid.

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