Low-Dose Morphine as Antitussive — SCE Palliative Medicine MCQ

Correct answer: B — Low-dose morphine MR 5 mg twice daily

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · A = shown as D · C = shown as E

NICE NG122 guidance for lung cancer recommends opioids (codeine or morphine) as the next step after simple measures fail for refractory cough. The UK task group on cough in lung cancer describes a stepped pyramid: demulcents → weak opioids → morphine/methadone → experimental approaches. Low-dose morphine MR (5 mg BD) represents appropriate escalation post-linctus failure, with a rational sustained-release formulation for chronic cough. Benzonatate (A) is peripherally acting and not UK cancer-guidance-endorsed. Inhaled corticosteroids (B) lack evidence for refractory cancer cough. Dextromethorphan (C) is a non-opioid centrally-acting agent but not advocated in UK cancer cough guidance; the dose cited is also high for initial use. Gabapentin (E) has RCT support (Ryan et al., Lancet 2012) for refractory cough and is a valid second-line option, particularly if neuropathic features are present, but is not the recommended first escalation post-linctus per NICE—morphine is preferred and better-established in the cancer setting.

Reference: NICE NG122 (2023). Lung cancer: diagnosis and management. Palliative interventions and supportive and palliative care section. https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care