What Is Your Gut Feeling About Opioid Rotation?

Didwaniya, Neha; Reddy, Akhila; Gottumukkala, Raju S.; Bruera, Éduardo

doi:10.1200/jco.2013.49.8204

Cited by 5 publications

(6 citation statements)

References 2 publications

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“…In most cases, the opioids used for BTP control were the same as those used as ER formulations for management of chronic background cancer pain. In our practice, we limit the use of different opioids for controlling background pain along with BTP at the same time, because using different opioids limits the choices for opioid rotation later in case of opioid‐induced neurotoxicity . Our study found that the single dose of oral IR opioid for BTP control was a median of 10% of the total MEDD (Table ), which confirms findings from previous studies and guidelines .…”

Section: Discussionsupporting

confidence: 87%

Response to Oral Immediate-Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain

et al. 2018

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Background There is limited evidence about the response of breakthrough pain (BTP) to the most commonly used oral immediate‐release (IR) opioids. Our aim was to determine response rate to oral IR opioids for BTP control in patients with advanced cancer. Materials and Methods In this prospective study, palliative care outpatients, with advanced cancer and adequately managed background pain, were asked to complete a self‐administered survey. We assessed patients’ baseline demographics, pain characteristics, alcoholism (CAGE questionnaire), tobacco and substance abuse, and Edmonton Symptom Assessment Scores (ESAS). We determined the effectiveness of oral IR BTP opioids by using a 7‐point Likert scale ranging from “very ineffective” to “very effective.” “Effective” and “very effective” were defined a priori as a good response to IR opioids for BTP. Results Of 592 evaluable patients, 192 (32%) had background pain of ≤3 (ESAS pain scale 0–10). Among these 192 patients, 152 (79%) reported BTP, 143/152 (94%) took oral IR opioids for BTP, and 127/143 (89%) responded to a median dose of 10% of the total morphine equivalent daily dose. In univariate logistic regression analysis, younger age (odds ratio [OR], 0.94 per year; p = .008), higher ESAS scores for pain (OR, 1.32; p = .012), anxiety (OR, 1.24; p = .017), and dyspnea (OR, 1.31; p = .007) had statistically significant association with poor response to IR opioids for BTP. In multicovariate logistic regression, adjusted for age, a higher ESAS dyspnea score was significantly associated with poor response to oral IR opioids (OR, 1.44; p = .002). Conclusion The vast majority of patients with advanced cancer with adequately controlled background pain reported a good response to oral IR opioids for BTP, supporting their use in clinical practice. Implications for Practice Oral immediate‐release opioids are standard treatment for cancer breakthrough pain. However, information regarding treatment response to these commonly used opioids is limited. This study provides information that the vast majority of patients with advanced cancer, with adequately controlled background pain, reported good response to oral immediate release opioids for managing their breakthrough pain episodes. Results of this study support the use of conventional oral immediate release opioids that are relatively inexpensive and readily available for management of breakthrough pain in patients with advanced cancer.

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Section: Discussionsupporting

confidence: 87%

Response to Oral Immediate-Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain

et al. 2018

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“…Chronic pain patients who have existing or emergent dysphagia (from mild difficulty swallowing to need for an enteral tube) pose a treatment challenge. One problem is with medication misuse, which can arise from attempts to crush, chew, or dissolve oral opioid ER formulations in an effort to facilitate swallowing or passage of the analgesic through an NG/G tube; a number of cases have been reported in the literature regarding overdose and unrelieved pain . Although extended‐release, bead‐in‐capsule formulations of morphine exist, these have limitations in their utility for dosing in patients that require enteral feeding tubes.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Extended‐Release, Abuse‐Deterrent, Microsphere‐in‐Capsule Analgesic for the Management of Patients with Chronic Pain With Dysphagia (CPD)

et al. 2015

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A new ER, abuse-deterrent, microsphere-in-capsule formulation of oxycodone can be administered by sprinkling onto soft food without affecting the drug release profile of the formulation. The formulation can also be administered directly via enteral tubes without affecting drug release and without clogging enteral tubes. Oxycodone DETERx® may offer physicians and patients with CPD an alternate treatment option, especially in those patients who have dysphagia or an aversion to swallowing monolithic tablet/capsule formulations and for whom analgesic patches or other opioid formulations are not a viable therapeutic option.

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“…A retrospective review of the use of oxymorphone immediate release for long term pain control in cancer patients with gastrostomy tubes administration is required, such as in cases of oral mucositis, dysphagia, and bowel obstruction (8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Original Articlementioning

confidence: 99%

“…Only methadone and immediate-release (IR) preparations of opioids can be administered per-tube, except for newer extendedrelease (ER) preparations of morphine and oxycodone which can be opened and the contents administered via G-tubes (8)(9)(10). However, these preparations are expensive and contraindicated in patients with bowel obstruction, ileus, and venting G-tubes (8)(9)(10)(11). Venting G-tubes are frequently placed in patients with bowel obstruction and allows for orally administered IR opioids to be absorbed higher up in the gastrointestinal (GI) tract when the G-tube is temporarily clamped after administration.…”

Section: Original Articlementioning

confidence: 99%

A retrospective review of the use of oxymorphone immediate release for long term pain control in cancer patients with gastrostomy tubes

Reddy¹,

Vidal²,

Haider³

et al. 2021

Ann Palliat Med

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Background: Cancer patients often require feeding or venting gastrostomy-tubes (G-tubes) for enteral nutrition or symptom palliation. The administration of most extended-release (ER) opioids via the G-tube or orally followed by clamping of the venting G-tube is contraindicated. Oxymorphone immediate release (IR) may be useful because of its longer half-life compared to other IR opioids. We examined the use of oxymorphone IR administered every 8 hours in patients with G-tubes.Methods: This was a retrospective chart review of 40 consecutive cancer patients with G-tubes who underwent opioid rotation (OR) to oxymorphone. Demographics, symptoms, morphine equivalent daily dose (MEDD), and oxymorphone dose were collected. Successful OR was defined as a 2-point or 30% reduction in pain score and continued use of oxymorphone at follow-up in outpatient setting, or discharge in inpatient setting. Opioid rotation ration (ORR) between MEDD and oxymorphone in patients with successful OR was calculated as MEDD before the OR divided by total oxymorphone dose/day at follow-up or discharge. Results:The median age was 56 years, 57.5% were white, 68% male, 47.5% (n=19) had head and neck cancer, 90% had advanced disease, 67.5% (n=27) were inpatient, and 15% (n=6) had venting G-tubes. 25/40 (62.5%) patients had successful OR to oxymorphone. The median ORR from MEDD to oxymorphone was 3.5 (IQR, 3.1-4). There were no independent predictors for successful OR, and ORR did not significantly differ among various groups.Conclusions: Oxymorphone IR can be used successfully in cancer patients with G-tubes using an ORR of 3.5 to calculate dose from MEDD.

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What Is Your Gut Feeling About Opioid Rotation?

Cited by 5 publications

References 2 publications

Response to Oral Immediate-Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain

Response to Oral Immediate-Release Opioids for Breakthrough Pain in Patients with Advanced Cancer with Adequately Controlled Background Pain

Evaluation of an Extended‐Release, Abuse‐Deterrent, Microsphere‐in‐Capsule Analgesic for the Management of Patients with Chronic Pain With Dysphagia (CPD)

A retrospective review of the use of oxymorphone immediate release for long term pain control in cancer patients with gastrostomy tubes

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