QONZA

*Pain:* BY SC INJ: Child 1-5 months: Initially 100-200 mcg/kg every 6 hrs. Child 6 months-1 yr: Initially 100-200 mcg/kg every 4 hrs. Child 2-11 yrs: Initially 200 mcg/kg every 4 hrs. Child 12-17 yrs: Initially 2.5-10 mg every 4 hrs. Doses to be adjusted according to response BY IV INJ: Child 1-5 months: 100 mcg/kg every 6 hrs, Child 6 months-11 yrs: 100 mcg/kg every 4 hrs. Child 12-17 yrs: 5 mg every 4 hrs. Dose to be adjusted according to response, dose to be administered over at least 5 minutes. ORAL OR BY RECTUM: Child 1-2 months: Initially 50-100 mcg/kg every 4 hrs, Child 3-5 months: 100-150 mcg/kg every 4 hrs, Child 6-11 months: 200 mcg/kg every 4 hours. Child 1 yr: Initially 200-300 mcg/kg every 4 hrs, Child 2-11 yrs: Initially 200-300 mcg/kg every 4 hrs (max. per dose 10 mg), Child 12-17 yrs: Initially 5-10 mg every 4 hrs. Dose to be adjusted adjusted according to response. *Acute pain:* ORAL, BY SC INJ, OR BY IM INJ: Adult: Initially 10 mg every 4 hours, adjusted according to response. Elderly and frail patients: Initially 5 mg every 4 hrs, adjusted according to response. Subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration. BY SLOW IV INJ: Adult: Initially 5 mg every 4 hrs, adjusted according to response, dose can be adjusted more frequently during titration, reduced dose in frail and elderly patients. *Chronic pain:* ORAL BY SC INJ, OR BY IM INJ: Adult: Initially 5-10 mg every 4 hrs, adjusted according to response, subcutaneous injection not suitable for oedematous patients. BY RECTUM: Adult: Initially 15-30 mg every 4 hrs, adjusted according to response. *Pain (with modified-release 12-hourly):* Adult: MR Tab every 12 hrs, dose adjusted according to daily morphine requirements. *Pain (with modified-release 24-hourly preparations):* Adult: MR Tab every 24 hours, dose adjusted according to daily morphine requirements. *Pain management in palliative care:* Adult: 20-30 mg daily in divided doses, using immediate-release preparation 4-hourly or a 12-hourly modified-release preparation, adjusted according to response. *Premedication:* BY SC INJ, OR BY IM INJ: Adult: Up to 10 mg, administered 60-90 mins before operation. *Myocardial infarction:* BY SLOW IV INJ: Adult: 5-10 mg, followed by 5-10 mg if required, administered at a rate of 1-2 mg/minute. Elderly: 2.5-5 mg, followed by 2.5-5 mg if required, administered at a rate of 1-2 mg/minute. *Acute pulmonary oedema:* BY SLOW IV INJ: Adult: 5-10 mg, administered at a rate of 2 mg/minute, Elderly and frail patients: 2.5-5 mg, administered at a rate of 2 mg/minute. *Dyspnoea at rest in palliative care:* Adult: Initially 5 mg every 4 hours, to be given in carefully titrated doses.

For continuous intravenous infusion, dilute with Glucose 5%or 10% or Sodium Chloride 0.9%

Heart failure, secondary to chronic lung disease, Phaeochromocytoma, acute respiratory depression, comatose patients, head injury, raised intracranial pressure, risk of paralytic ileus

Hepatic impairment; avoid oral preparations in acute impairment cardiac arrhythmias, pancreatitis . severe cor Pulmonale, Avoid use or reduce dose renal impairment; opioid effects increased and prolonged; increased cerebral sensitivity. Close monitoring for acute chest syndrome symptoms during treatment in patients with sickle cell disease treated with morphine during a vaso-occlusive crisis.

Opioid antagonists, MAOis or CNS depressants, TCADs, rifampicin, cimetidine, muscle relaxants, antihypertensive drugs, metoclopramide, mexiletine, gabapentin, voriconazole, ritonavir

Appetite decreased, neuromuscular dysfunction, GI discomfort, asthenic conditions, insomnia, agitation, bronchospasm, ileus, mood altered, alertness decreased, myoclonus, peripheral oedema, pulmonary oedema, taste altered, vision disorders, sexual dysfunction. Rare: Seizure, sensation abnormal, syncope, bile duct disorders, vertigo, ureteral spasm, urinary disorders.