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Swallowing immediate-release morphine is as effective as sublingual administration for pain relief and plasma morphine concentrations. However, swallowing offers a better taste experience, potentially improving patient adherence to morphine therapy.

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Area of Science:

  • Pharmacology
  • Pain Management

Background:

  • The optimal route for immediate-release morphine is debated, with a common misconception that sublingual morphine offers faster absorption.
  • Morphine's physical properties supporting absorption are not aligned with the belief in rapid sublingual uptake.

Purpose of the Study:

  • To compare swallowed versus sublingual morphine regarding plasma morphine concentrations (PMCs), pain relief, and taste perception.
  • To investigate the efficacy and patient experience of different immediate-release morphine administration routes.

Main Methods:

  • A randomized crossover study involving ten cancer patients (mean age 50 ± 12 years).
  • Participants received a 10-mg morphine tablet via both swallowed and sublingual routes, with measurements taken over 60 minutes.
  • Plasma morphine concentrations and visual analog scale scores for pain relief and taste were assessed.

Main Results:

  • No significant difference was found between swallowed and sublingual routes for mean area under the curve for plasma morphine concentrations (PMC) or mean pain relief scores at 60 minutes.
  • Taste scores were significantly less unpleasant for swallowed morphine compared to sublingual at multiple time points (5, 10, 15, and 20 minutes).
  • A substantial 25-fold interindividual variability in maximum PMC was observed.

Conclusions:

  • Swallowed and sublingual morphine yield similar PMCs and pain relief outcomes in this study.
  • Significant interindividual variability in PMC necessitates further research to identify contributing factors.
  • Due to unpleasant taste, swallowing morphine is recommended, reserving sublingual use for patients unable to swallow.