Table 1.

Commonly Used Morphine Treatment Regimens (based on Finnegan Scoring every 4 h)

Weight based	Symptom based16,19 ( doses are not based on body weight) RE-specify to avoid confusion or errors
Initial dose: 0.4 mg/kg/day divided every 4 h Dose Increase: 20%/day for NAS scores > 24 total on three measures, or a single score ≥12. Weaning Dose: After 48 hours of clinical stability, reduce dose by 10% every 24–48 hours Reduce dose when the sum of the previous three scores is < 18 and no single score is > 8. Cease therapy when dose is 0.15 mg/kg/day. Rescue dose: Administer additional morphine at previous dose for inadequate symptom between scheduled dose intervals. What dose–same dose? Adjunctive treatment: At dose of morphine 1.25 mg/kg/day initiate second medication *	Initial dose ( not based on body weight? For first score >8, re-score in one hour to verify. If still elevated:
	Single NAS score	Dose q4h
	9–12	0.04 mg
	13–16	0.08 mg
	17–20	0.12 mg
	21–24	0.16 mg
	>25	0.20 mg
	Dose Increase:
	Single NAS score	Increase Dose
	0–9	None
	9–12	0.02 mg
	13–16	0.04 mg
	17–20	0.06 mg
	Weaning Dose: After 48 hours of clinical stability, reduce dose by 0.02 mg every 24 hours if scores in general <8 For first elevated score >8, rescore in one hour to verify. If still elevated
	Two NAS scores	Increase Dose
	9–12	0.01 mg
	13–16	0.02 mg
	17–20	0.04 mg
	Cease therapy when dose is 0.02 mg
	Adjunctive treatment: At dose of morphine 1.6 mg/day initiate second medication*

^*phenobarbital loading dose of 20 mg/kg followed by 5 mg/kg/day OR clonidine