Morphine titration in the elderly
In elderly patients, a reduced dose of opioids is usually
recommended because of changes in pharmacokinetics
and pharmacodynamics. There is a 50% reduction in clearance,
and a reduction in protein binding,32 and increased
brain sensitivity to the effects of opioids.33 However,
because of the variability in dose requirements and as a titration
adapts the dose to the pain, there is no evidence that a
titration protocol should also take into account the age of the
patients. On the assumption that titration is performed over
a short period in which age-related changes in pharmacokinetics
and pharmacodynamics might be less important,
studies using the same protocol of i.v. morphine titration in
young and elderly patients (≥70 yr) have been done.7–10
The VAS scores were not significantly different in the two
groups before, during, and at the end of morphine titration,
and the number of patients with pain relief was also equivalent.
9 When the dose of titrated morphine was normalized
for body weight (lower in elderly patients), no significant difference
was observed between groups (Fig. 5). The number of
morphine-related adverse effects, the number of sedated
patients, and the number of patients requiring termination
of morphine titration were not different.10 A study after hip
Morphine titration in the elderly
In elderly patients, a reduced dose of opioids is usually
recommended because of changes in pharmacokinetics
and pharmacodynamics. There is a 50% reduction in clearance,
and a reduction in protein binding,32 and increased
brain sensitivity to the effects of opioids.33 However,
because of the variability in dose requirements and as a titration
adapts the dose to the pain, there is no evidence that a
titration protocol should also take into account the age of the
patients. On the assumption that titration is performed over
a short period in which age-related changes in pharmacokinetics
and pharmacodynamics might be less important,
studies using the same protocol of i.v. morphine titration in
young and elderly patients (≥70 yr) have been done.7–10
The VAS scores were not significantly different in the two
groups before, during, and at the end of morphine titration,
and the number of patients with pain relief was also equivalent.
9 When the dose of titrated morphine was normalized
for body weight (lower in elderly patients), no significant difference
was observed between groups (Fig. 5). The number of
morphine-related adverse effects, the number of sedated
patients, and the number of patients requiring termination
of morphine titration were not different.10 A study after hip
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