MST Continus tablets should be used twice daily, at 12-hrly intervals. The dosage is dependent upon the severity of the pain, the patient's age and previous history of analgesic requirements.
A patient presenting with severe pain should normally be started on a dosage of 1 or 2 MST Continus tablets 10 mg twice daily.
Persisting or increasing severity of pain will require increased dosage of MST Continus tablets using 10-mg, 30-mg and 60-mg tablets alone or in combination to achieve the desired pain relief. Increases of the dosage should be made in 25-50% increments.
A patient transferred from immediate-release oral morphine preparations should normally receive the same total 24-hr morphine dosage divided between morning and evening administration.
Patients receiving MST Continus tablets in place of parenteral morphine should be given a sufficiently increased dosage to compensate for any reduction in analgesic effects associated with oral administration. Usually such increased requirement is of the order of 50-100%. In such patients, individual dose adjustments are required.
Postoperative Pain: MST Continus tablets are not recommended in the first 24 hrs postoperatively; thereafter it is suggested that the following dosage schedule be observed at the physician's discretion: a) MST Continus tablets 20 mg 12-hrly to patients <70 kg. b) MST Continus tablets 30 mg 12-hrly to patients >70 kg.
Supplemental parenteral morphine may be given if required but with careful attention to the total dosage of morphine and bearing in mind the prolonged effects of morphine in the MST Continus formulation.
As with oral morphine preparations, MST Continus tablets should be used with caution postoperatively and particularly in "acute abdomen" and following abdominal surgery.
Transferability: It is not possible to ensure bioequivalence between different prolonged-release morphine products. Therefore, it should be emphasized that patients, once titrated to an effective dose, should not be changed from MST Continus tablet to other slow, sustained-release or prolonged-release morphine preparations without re-titration and clinical assessment.
Administration: MST Continus tablets must be swallowed whole and not chewed.