Opioid switching: A systematic and critical review

Mercadante, Sebastiano; Bruera, Éduardo

doi:10.1016/j.ctrv.2006.03.001

Cited by 217 publications

(162 citation statements)

References 47 publications

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“…A medication profile review and an increase in the Anticholinergic Risk Scale will assist in identifying potential deliriogenic medications that can be dose-reduced or discontinued (50,51). Apart from the imminently dying context (last hours of life), an opioid switch (with a reduction in opioid equianalgesic dose by 30-50%) also may be appropriate if signs of opioid-induced neurotoxicity are present, although there remains a lack of high level evidence for this strategy in delirious patients (52,53). Although complete or partial reversal of the delirium may be possible, approximately 50% of delirium episodes in palliative care patients cannot be reversed, based on a study conducted in a tertiary palliative care unit in an acute care hospital (6).…”

Section: Delirium Reversibility In End-of-life Carementioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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Section: Delirium Reversibility In End-of-life Carementioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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“…In this practice, the equivalent analgesic doses of different opioids should be well known. Equivalent analgesic doses are provided by routes of administration for each opioid (Mercadante and Bruera, 2006;Ripamonti and Bandieri, 2009).…”

Section: Who Guideline For Steps and Pharmacological Treatmentmentioning

confidence: 99%

Cancer Pain Prevalence and its Management

Arslan¹,

Koca²,

Akar³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Pain is a public health problem affecting more than half of cancer patients. Despite the success of the protocols currently used, pain cannot still be reduced satisfactorily in the large majority of patients. In order to improve pain management, all healthcare professionals involved with pain should have sufficient knowledge on pain assessment and treatment, and should inform patients to prevent patient-related barriers. In this compilation, the prevalence values and the treatment methods of cancer pain, and the barriers to pain management have been assessed.

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“…The advantages of using methadone for refractory pain or adverse effects with other opioids have been invariably reported in literature [8]. The absence of known metabolites allowing a safe use with renal failure, extra-opioid activity on NMDA receptor system, and low cost are the positive Table 2 Data of patients who completed the switching from oxycodone to methadone successfully at the different intervals considered Fig.…”

Section: Discussionmentioning

confidence: 98%

“…Given the increasing use of oxycodone, even at high doses, it is likely that some patients may not respond and require an opioid switching. Previous studies have shown outcomes and conversion ratios between morphine, hydromorphone, and transdermal fentanyl [8]. However, switching from oxycodone to methadone has never been assessed and an indirect conversion ratio with morphine has been used in some circumstances [9].…”

Section: Introductionmentioning

confidence: 99%

Switching from oxycodone to methadone in advanced cancer patients

Mercadante¹,

Ferrera

Villari

et al. 2011

Support Care Cancer

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Purpose The aim of this study was to prospectively evaluate the outcomes and the conversion ratio of switching from oxycodone to methadone in advanced cancer patients admitted to an acute palliative care unit. Patients and methods A prospective study was carried out on a cohort of consecutive sample of patients receiving oxycodone, who were switched for different reasons mainly because of an inconvenient balance between analgesia and adverse effects. An initial conversion ratio between oxycodone and methadone was 3.3:1. Intensity of pain and symptoms associated with opioid therapy were recorded, and a distress score (DS) was also calculated as a sum of symptom intensity. A successful switching was considered when the intensity of pain and/or DS or the principal symptom requiring switching decreased at least of 33% of the value recorded before switching. Results Nineteen out of 542 patients admitted to the unit in 1 year underwent a switching from oxycodone to methadone.Almost all substitutions were successful. The prevalent indication for opioid switching was uncontrolled pain and adverse effects (12 patients). No significant changes between the initial conversion ratio and final conversion ratio between the two opioids were found. Conclusion Switching from oxycodone to methadone is a reliable method to improve the opioid response in advanced cancer patients. A ratio of 3.3 appears to be reliable, even at high doses. Further studies should be performed to confirm these results in other settings and with very high doses of oxycodone.

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Opioid switching: A systematic and critical review

Cited by 217 publications

References 47 publications

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Cancer Pain Prevalence and its Management

Switching from oxycodone to methadone in advanced cancer patients

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