Equipotent doses to switch from high doses of opioids to transdermal buprenorphine

Mercadante, Sebastiano; Casuccio, Alessandra; Tirelli, Walter; Giarratano, A

doi:10.1007/s00520-008-0546-6

Cited by 41 publications

(32 citation statements)

References 10 publications

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“…Buprenorphine, a partial mu-receptor agonist, does not appear to produce clinically negative effects on pain control during opioid switching 34,35. TD-Bu is available in several dosing strengths (5, 10, 15, 20, 35, 52.5, and 70 μg/hr).…”

Section: Td-bu Rotationmentioning

confidence: 99%

“…Published data for conversion to TD-Bu is less robust and a variety of conversion ratios have been utilized 23. There have been two N of 1 studies performed in cancer patients with stable pain control that support the use of a 75:1 relative analgesic potency for switching from PO morphine to TD-Bu 34,35. Thus, a dose of 60 mg/day of PO morphine would equate to 0.8 mg/day of TD-Bu or 35 μg/hr 34,35.…”

Section: Td-bu Rotationmentioning

confidence: 99%

“…There have been two N of 1 studies performed in cancer patients with stable pain control that support the use of a 75:1 relative analgesic potency for switching from PO morphine to TD-Bu 34,35. Thus, a dose of 60 mg/day of PO morphine would equate to 0.8 mg/day of TD-Bu or 35 μg/hr 34,35. The first study involved converting 10 cancer patients who were receiving stable doses of PO Morphine or TD-Fe for more than 6 days with no more than 2 daily IR PO morphine breakthrough doses to TD-Bu 34.…”

Section: Td-bu Rotationmentioning

confidence: 99%

“…Thus, a dose of 60 mg/day of PO morphine would equate to 0.8 mg/day of TD-Bu or 35 μg/hr 34,35. The first study involved converting 10 cancer patients who were receiving stable doses of PO Morphine or TD-Fe for more than 6 days with no more than 2 daily IR PO morphine breakthrough doses to TD-Bu 34. No statistically significant changes in pain, symptom intensity, and global satisfaction with analgesic pharmacotherapy were observed 34.…”

Section: Td-bu Rotationmentioning

confidence: 99%

“…The first study involved converting 10 cancer patients who were receiving stable doses of PO Morphine or TD-Fe for more than 6 days with no more than 2 daily IR PO morphine breakthrough doses to TD-Bu 34. No statistically significant changes in pain, symptom intensity, and global satisfaction with analgesic pharmacotherapy were observed 34. Constipation was significantly ( P =0.014) improved with the conversion to TD-Bu 34.…”

Section: Td-bu Rotationmentioning

confidence: 99%

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Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain

Skaer¹

2014

JPR

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Opioids continue to be first-line pharmacotherapy for patients suffering from cancer pain. Unfortunately, subtherapeutic dosage prescribing of pain medications remains common, and many cancer patients continue to suffer and experience diminished quality of life. A large variety of therapeutic options are available for cancer pain patients. Analgesic pharmacotherapy is based on the patient’s self-report of pain intensity and should be tailored to meet the requirements of each individual. Most, if not all, cancer pain patients will ultimately require modifications in their opioid pharmacotherapy. When changes in a patient’s medication regimen are needed, adequate pain control is best maintained through appropriate dosage conversion, scheduling immediate release medication for withdrawal prevention, and providing as needed dosing for breakthrough pain. Transdermal opioids are noninvasive, cause less constipation and sedation when compared to oral opioids, and may improve patient compliance. A relative potency of 100:1 is recommended when converting the patient from oral morphine to transdermal fentanyl. Based on the limited data available, there is significant interpatient variability with transdermal buprenorphine and equipotency recommendations from oral morphine of 75:1–110:1 have been suggested. Cancer patients may require larger transdermal buprenorphine doses to control their pain and may respond better to a more aggressive 75–100:1 potency ratio. This review outlines the prescribing of transdermal fentanyl and transdermal buprenorphine including how to safely and effectively convert to and use them for those with cancer pain.

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Section: Td-bu Rotationmentioning

confidence: 99%

Section: Td-bu Rotationmentioning

confidence: 99%

Section: Td-bu Rotationmentioning

confidence: 99%

Section: Td-bu Rotationmentioning

confidence: 99%

Section: Td-bu Rotationmentioning

confidence: 99%

See 3 more Smart Citations

Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain

Skaer¹

2014

JPR

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Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain

et al. 2021

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IMPORTANCE Individuals with chronic pain who use long-term opioid therapy (LTOT) are at risk of opioid use disorder and other harmful outcomes. Rotation to buprenorphine may be considered, but the outcomes of such rotation in this population have not been systematically reviewed.OBJECTIVE To synthesize the evidence on rotation to buprenorphine from full μ-opioid receptor agonists among individuals with chronic pain who were receiving LTOT, including the outcomes of precipitated opioid withdrawal, pain intensity, pain interference, treatment success, adverse events or adverse effects, mental health condition, and health care use. EVIDENCE REVIEW PubMed, CINAHL, Embase, and PsycInfo were searched from inception through November 3, 2020, for peer-reviewed original English-language research that reported the prespecified outcomes of rotation from prescribed long-term opioids to buprenorphine among individuals with chronic pain. Two independent reviewers extracted data as well as assessed risk of bias and study quality according to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) reporting guidelines. Quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. FINDINGS A total of 22 studies were analyzed, of which 5 (22.7%) were randomized clinical trials, 7 (31.8%) were case-control or cohort studies, and 10 (45.5%) were uncontrolled pre-post studies, which involved 1616 unique participants (675 female [41.8%] and 941 male [58.2%] individuals). Six of the 22 studies (27.3%) were primary or secondary analyses of a large randomized clinical trial.Participants had diverse pain and opioid use histories. Rationale for buprenorphine rotation included inadequate analgesia, intolerable adverse effects, risky opioid regimens (eg, high dose and/or sedative coprescriptions), and aberrant opioid use. Most protocols were adapted from protocols for initiating treatment in patients with opioid use disorder and used buccal or sublingual buprenorphine. Very low-quality evidence suggested that buprenorphine rotation was associated with maintained or improved analgesia, with a low risk of precipitating opioid withdrawal. Steadydose buprenorphine was better tolerated than tapered-dose buprenorphine. Adverse effects were manageable, and severe adverse events were rare. Only 2 studies evaluated mental health outcomes, but none evaluated health care use. Limitations included a high risk of bias in most studies. CONCLUSIONS AND RELEVANCEIn this systematic review, buprenorphine was associated with reduced chronic pain intensity without precipitating opioid withdrawal in individuals with chronic pain who were receiving LTOT. Future studies are necessary to ascertain the ideal starting dose, formulation, and administration frequency of buprenorphine as well as the best approach to buprenorphine rotation.

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Buprenorphine for treating cancer pain

Schmidt‐Hansen¹,

Bromham²,

Taubert³

et al. 2013

Cochrane Database of Systematic Reviews

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Equipotent doses to switch from high doses of opioids to transdermal buprenorphine

Abstract: The results of this study suggest that stable patients receiving relatively high doses of oral morphine or TD fentanyl could be safely switched to TD BUP, by using a ratio of 70:1 and 0.6:0.8, respectively, maintaining the same level of analgesia.

Cited by 41 publications

References 10 publications

Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain

Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain

Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain

Buprenorphine for treating cancer pain

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