Fentanyl Tolerance in the Treatment of Cancer Pain: A Case of Successful Opioid Switching From Fentanyl to Oxycodone at a Reduced Equivalent Dose

Abstract

Opioids are not generally deemed to have an analgesic ceiling effect on cancer pain. However, there have been occasional reports of tolerance to opioid development induced by multiple doses of fentanyl. The authors report a case of suspected tolerance to the analgesic effect of opioid, in which an increasing dose of fentanyl failed to relieve the patient's cancer pain symptoms, but opioid switching to oxycodone injections enabled a dose reduction to below the equivalent dose conversion ratio. The patient was a 60-year-old man diagnosed with pancreatic body carcinoma with multiple metastases. The base dose consisted of 12 mg/day of transdermal fentanyl patches (equivalent to 3.6 mg/day, 150 μg/h fentanyl injection), and rescue therapy consisted of 10 mg immediate-release oxycodone powders. Despite the total daily dose of fentanyl reaching 5.6 mg (equivalent to 560 mg oral morphine), the analgesic effect was inadequate; thus, an urgent adjustment was necessary. Due to the moderate dose of fentanyl, the switch to oxycodone injection was done incrementally at a daily dose equivalent to 25% of the fentanyl injection. The total dose of oxycodone was replaced approximately 53.5% of the dose of fentanyl prior to opioid switching.

Covalently Loaded Naloxone Nanoparticles as a Long-Acting Medical Countermeasure to Opioid Poisoning

“…An undesirable side effect that can accompany the repeated use of potent opioid analgesics is the development of tolerance. , Prior to initiation of a repeated fentanyl dosing study, it was important to determine the extent of fentanyl tolerance in the respiratory depression and antinociceptive assays. On Day 1, rats ( n = 4) were tested on the hot plate and the oxygen saturation was measured.…”

Opioid Analgesia and Opioid-Induced Adverse Effects: A Review

“…The clinical management of analgesic tolerance involves opioid rotation and the combination of opioids with adjuvants [124][125][126][127]. Adjuvants, such as gabapentin, pregabalin, dexamethasone, naproxen, ibuprofen, carbamazepine, aspirin, venlafaxine and acetaminophen, are combined with opioid analgesics in patients that require long-term analgesic treatment [128,129].…”

Διερεύνηση Της Επίδρασης Της Μουσικής Στην Αναισθησία Και Στην Αναλγησία Του Σκύλου

“…Στην παρούσα μελέτη κρίθηκε σκόπιμο, τα ζώα που θα συμμετάσχουν τόσο στο πειραματικό όσο και στο κλινικό μέρος, να μην έχουν εκτεθεί σε χρόνια χορήγηση ηρεμηστικών, αντικαταθλιπτικών, οπιοειδών ή άλλων αναλγητικών φαρμάκων, καθώς έχει αναφερθεί "αντοχή" (tolerance) μετά από χρόνια χορήγηση α₂ αγωνιστών (Reid et al 1994, Hayashi et al 1995), βενζοδιαζεπινών (Fernandes et al 1999, Divljakovic et al 2012, φαινοθειαζινών (Kolakowska et al 1976) και οπιοειδών (Kissin et al 1991, Vinik and Kissin 1998, Guignard et al 2000, Hayashida et al 2003, Gaynor and Muir 2014, Sutou et al 2015.…”