No abstract

No abstract

Although the minimum effective dose of the once-a-day fentanyl citrate transdermal patch (tape) used for cancer pain is 1 mg, this may be excessive depending on the patient＇s condition. The dosage may be lowered using film dressing because the tape cannot be cut and patched; however, the feasibility of dose adjustment using this method is not confirmed. The tape was covered with OPSITE ＊ FLEXIFIX (OP), PERME-ROLL (PE), or Tegaderm TM Roll (TE) as film dressings, adopting 2 methods: (1) bonding the application surfaces of the tape and film dressing; or (2) pasting the tape on the surface of the film dressing. From the results of the drug release test and skin permeability test, OP was found to prevent drug release more markedly when adopting method (1). During hospitalization at the Ashiya Municipal Hospital, the tapes were applied in the following dosages to each patient: A (1 mg and 0.5 mg), and B-D (0.5 mg). Administration of 0.5 mg was performed using PE with method (2). The residual rate for each patient was: A: 80.6％, B: 74.6 ± 8.39％, C: 75.6 ± 4.37％, and D: 79.4 ± 8.31％. When the tape at 1 mg was attached to patient A, the residual rate was 61.1 ± 9.50％. These results support the feasibility of dose adjustment by covering the drug releasing surface of the tape with appropriate film dressing, such as OP or PE, adopting method (2).

No abstract

The dose of opioids prescribed for cancer pain does not always correlate with the actual pain severity. However, there is little evidence to explain this observation. In the present study, we sought to determine factors that influence the dose of opioid analgesics. A total of 227 patients who were administered opioids between August 2012 and May 2016 and later expired within the Department of Palliative Care at Ashiya Municipal Hospital were included, and the following variables were examined: age, sex, type of cancer, Verbal Rating Scale before and after the administration of the maximum prescribed dose of opioids, type of opioids and route of administration, blood test results, pain severity, and use of adjuvants. Data were analyzed using step-wise multiple linear regression. Median of the maximum prescribed dose of opioids, expressed in oral morphine equivalent, was 68.6, 60.0, and 39.2 mg for patients aged 65, 65-74, and ≥75 years, respectively. Step-wise multiple linear regression analysis further demonstrated that an increase in age by 1 year decreased the maximum prescribed dose of opioids by 0.98-fold (p = 0.006). Other factors that influenced the maximum prescribed dose of opioids included the use of analgesic adjuvants (1.91-fold, p = 0.001), oral administration (0.54-fold, p = 0.016), and elevated level of bilirubin (0.95-fold by 0.1 mg/dL increase, p = 0.013). Opioids examined in the study are metabolized in the liver by cytochromes P450 or by glucuronidation. Thus, if reduced drug metabolism causes the reduction in the maximum prescribed dose of opioids, liver function may contribute to this effect. Based on our findings that old age is associated with a lower prescribed dose of opioids, future studies should examine additional variables included in laboratory tests in more detail and measure hepatic blood flow to determine the cause of this association.