This strategy can be useful if a patient with good pain control presents with a toxicity such as sedation. However, where pain is not well controlled, dose reducation is not feasible. Discontinuing the opioid altogether is most often not an option in palliative patients. There are no studies comparing the effectiveness of dose reduction versus opioid switching/rotation in managing these toxicities. It appears that some patients, particularly those with poor pain control and moderate to severe toxicities will do best with an opioid rotation while others will simply require a dose reduction.

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Clinical Presentation
Underlying Mechanisms
Assessment of toxicities
Overall management
Opioid rotation
Opioid dose reduction
Addition of other drugs
Hydration
References
Credits