ONCE A WEEK patch (7-day patch)

For specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties

Patches should be prescribed by BRAND

TWICE WEEKLY patch

For specialist initiation: specialist pain clinics, palliative care and for patients with swallowing difficulties

Patches should be prescribed by BRAND

Specialist use only

For use in opioid dependence, see section 4.10.3

Tablets

25mg/5ml syrup

Use with caution in patients aged over 65

Contraindicated in children below the age of 12

Tablets

Oral solution for patients with swallowing difficulties

For patients with swallowing difficulties on stable doses of opiates or on pain team specialist advice when morphine is not suitable.
Prescribe by brand.
Follow Optimise Rx advice for most cost effective brand

For use in opiod dependence, see section 4.10.3

  Tablets

                M/R tablets

                M/R capsules

                Oral solution

                Injection

  Suppositories

                100mg/100ml PCA

                5mg/5ml intrathecal injection

                pre-filled syringe

Specialist initiation- pain clinic

Modified release(MR) preparation should be used for regular dosing. Immediate release preparations may be associated with tolerance and problem drug use.

Follow Optimise Rx advice for most cost effective brand / formulation

Injectable formulations for palliative care only

Capsules

M/R tablets

SF solution

For patients who do not tolerate morphine

Specialist initiation
Pain clinic and palliative care use only

Third line after morphine and codeine

Please note modified release preparations are non-formulary

Third line after morphine and codeine

Only for patients with swallowing difficulties

Capsules more cost effective

In line with NHS England's Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)

Click here to access guidance

In line with NHS England's Guidance for CCGs: Items which should not routinely be prescribed in primary care (Dec 2017)

Click here to access guidance