Geriatrics and Palliative Caremiddle twist
A 77-year-old man with metastatic prostate cancer and an estimated glomerular filtration rate of 18 mL/min/1.73 m² has been receiving regular oral morphine. Over 2 days he has developed increasing drowsiness, vivid dreams and intermittent multifocal myoclonus, without severe pain at rest. His family asks for a larger morphine dose because he sometimes reports pain when repositioned. Which management is most appropriate?