{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:51:53Z","timestamp":1772758313070,"version":"3.50.1"},"reference-count":20,"publisher":"BMJ","issue":"6692","license":[{"start":{"date-parts":[[1989,7,15]],"date-time":"1989-07-15T00:00:00Z","timestamp":616464000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1989,7,15]]},"abstract":"<jats:p>OBJECTIVE--To estimate the prevalence of important side effects in patients with malignant disease who were receiving high doses of morphine as part of their palliative treatment. DESIGN--Data on patients were collected over 12 months. SETTING--Two palliative care units in Western Australia. PATIENTS--19 Patients with malignant disease who were receiving morphine either subcutaneously or orally as the main analgesic. 10 Patients receiving a total daily dose of morphine of at least 500 mg orally or 250 mg parenterally were enrolled in the study. The other 9 patients were enrolled after an important problem thought to be related to the morphine had been identified. All of the patients were taking drugs to supplement the treatment. INTERVENTIONS--The dose of morphine or route of administration, or both, was changed in three patients. MAIN OUTCOME MEASURE--Determination of the prevalence of side effects in the patients. Assessment of the relation of any side effects with the supplemental drugs taken by the patients. MAIN RESULTS--Plasma morphine and electrolyte concentrations were measured and a full history taken for each patient. Thirteen of the 19 patients had an important side effect; 12 of them had myoclonus and one had hyperalgesia of the skin. Plasma morphine concentrations were similar in patients with and without myoclonus, ranging from 158 to 3465 nmol\/l and 39 to 2821 nmol\/l respectively. Eight of the patients with side effects were taking an antipsychotic drug concurrently compared with none of those without side effects. A greater proportion of patients with side effects were taking the antinauseant drug thiethylperazine (6\/13 v 2\/6) and at least one non-steroidal anti-inflammatory drug (10\/13 v 2\/6), whereas a smaller proportion were taking a glucocorticosteroid (3\/13 v 4\/6). The estimated prevalence of important side effects in the total population of patients receiving palliative treatment in the two units was 2.7-3.6%. CONCLUSIONS--Myoclonus as a side effect of treatment with morphine is more likely to occur in patients taking antidepressant or antipsychotic drugs as antiemetics or as adjuvant agents or non-steroidal anti-inflammatory drugs for additional analgesia. If a patient develops myoclonus the best approach may be to change the supplemental treatment.<\/jats:p>","DOI":"10.1136\/bmj.299.6692.150","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"150-153","source":"Crossref","is-referenced-by-count":83,"title":["Myoclonus associated with treatment with high doses of morphine: the role of supplemental drugs."],"prefix":"10.1136","volume":"299","author":[{"given":"J. M.","family":"Potter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. B.","family":"Reid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. J.","family":"Shaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Hackett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. 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Palliative Medicine 1989;3:65-6.","journal-title":"Palliative Medicine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0379-0738(87)90055-7","article-title":"The measurement and interpretation of morphine in blood","volume":"35","author":"Logan, B.K.; Oliver, J.S.; Smith, H.","year":"1987","unstructured":"Logan BK, Oliver JS, Smith H. The measurement and interpretation of morphine in blood. Forensic Sci nt 1987;35:189-95.","journal-title":"Forensic Sci nt"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"219","DOI":"10.2165\/00003088-197601030-00004","article-title":"The relationship of pharmacokinetics to pharmacological activity; morphine, methadone and naloxone","volume":"1","author":"Berkowitz, B.A.","year":"1976","unstructured":"Berkowitz BA. The relationship of pharmacokinetics to pharmacological activity; morphine, methadone and naloxone. 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