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Rapid switching between transdermal fentanyl and methadone in cancer patients.
J Clin Oncol. 2005 Aug 01; 23(22):5229-34.JC

Abstract

PURPOSE

The aim of this study was to examine the clinical effects of switching from transdermal (TTS) fentanyl to methadone, or vice versa, in patients with a poor response to the previous opioid.

PATIENTS AND METHODS

A prospective study was carried out on 31 patients who switched from TTS fentanyl to oral methadone, or vice versa, because of poor opioid response. A fixed conversion ratio of fentanyl to methadone of 1:20 was started and assisted by rescue doses of opioids, and then doses were changed according to clinical response. Pain and symptom intensity, expressed as distress score, were recorded before switching doses of the two opioids and after subsequent doses. The number of changes of the daily doses, time to achieve stabilization, and hospital stay were also recorded.

RESULTS

Eighteen patients were switched from TTS fentanyl to methadone, and seven patients were switched from methadone to TTS fentanyl. A significant decrease in pain and symptom intensity, expressed as symptom distress score, was found within 24 hours after switching took place in both directions. Unsuccessful switching occurred in six patients, who were subsequently treated with an alternative therapy.

CONCLUSION

A rapid switching using an initial fixed ratio of fentanyl to methadone of 1:20 is an effective method to improve the balance between analgesia and adverse effects in cancer patients with poor response to the previous opioid. No relationship between the final opioid dose and the dose of the previous opioid has been found.

Authors+Show Affiliations

Anesthesia and Intensive Care Unit, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy. terapiadeldolore@la-maddalena.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

16051965

Citation

Mercadante, Sebastiano, et al. "Rapid Switching Between Transdermal Fentanyl and Methadone in Cancer Patients." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 23, no. 22, 2005, pp. 5229-34.
Mercadante S, Ferrera P, Villari P, et al. Rapid switching between transdermal fentanyl and methadone in cancer patients. J Clin Oncol. 2005;23(22):5229-34.
Mercadante, S., Ferrera, P., Villari, P., & Casuccio, A. (2005). Rapid switching between transdermal fentanyl and methadone in cancer patients. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 23(22), 5229-34.
Mercadante S, et al. Rapid Switching Between Transdermal Fentanyl and Methadone in Cancer Patients. J Clin Oncol. 2005 Aug 1;23(22):5229-34. PubMed PMID: 16051965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rapid switching between transdermal fentanyl and methadone in cancer patients. AU - Mercadante,Sebastiano, AU - Ferrera,Patrizia, AU - Villari,Patrizia, AU - Casuccio,Alessandra, PY - 2005/7/30/pubmed PY - 2005/9/15/medline PY - 2005/7/30/entrez SP - 5229 EP - 34 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J Clin Oncol VL - 23 IS - 22 N2 - PURPOSE: The aim of this study was to examine the clinical effects of switching from transdermal (TTS) fentanyl to methadone, or vice versa, in patients with a poor response to the previous opioid. PATIENTS AND METHODS: A prospective study was carried out on 31 patients who switched from TTS fentanyl to oral methadone, or vice versa, because of poor opioid response. A fixed conversion ratio of fentanyl to methadone of 1:20 was started and assisted by rescue doses of opioids, and then doses were changed according to clinical response. Pain and symptom intensity, expressed as distress score, were recorded before switching doses of the two opioids and after subsequent doses. The number of changes of the daily doses, time to achieve stabilization, and hospital stay were also recorded. RESULTS: Eighteen patients were switched from TTS fentanyl to methadone, and seven patients were switched from methadone to TTS fentanyl. A significant decrease in pain and symptom intensity, expressed as symptom distress score, was found within 24 hours after switching took place in both directions. Unsuccessful switching occurred in six patients, who were subsequently treated with an alternative therapy. CONCLUSION: A rapid switching using an initial fixed ratio of fentanyl to methadone of 1:20 is an effective method to improve the balance between analgesia and adverse effects in cancer patients with poor response to the previous opioid. No relationship between the final opioid dose and the dose of the previous opioid has been found. SN - 0732-183X UR - https://www.unboundmedicine.com/medline/citation/16051965/Rapid_switching_between_transdermal_fentanyl_and_methadone_in_cancer_patients_ L2 - https://ascopubs.org/doi/10.1200/JCO.2005.13.128?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -