There are numerous reports describing improvement or resolution in adverse effects from opioids after switching to an alternative opioid. These reports consist of a prospective study and numerous restrospective studies and case reports. Switching the opioid, often refferred to as "opioid rotation," allows the metabolites and offending opioid to be eliminated while maintaining analgesia with a strong opioid. This strategy can be particularly useful when the toxicity is severe and/or pain is not well controlled. Switching the opioid requires the use of equianalgesic dose tables. Given the interindividual variability in response to various opioids, these should be viewed as guidelines and close patient monitoring is essential. There is no sound evidence to suggest superiority of one opioid over another, but some theoretical support of methadone as a useful second line opioid.
Clinical Presentation
Underlying Mechanisms
Assessment of toxicities
Overall management
Opioid rotation
Opioid dose reduction
Addition of other drugs
Hydration
References
Credits
Content for this flash card was provided by Dr. Jose Pereira and Jacqui Peden RN MN. For full credits click here.