Transdermal opioids for cancer pain

Tracy L Skaer

doi:10.1186/1477-7525-4-24

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Journal article

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Peer reviewed

Transdermal opioids for cancer pain

Tracy L Skaer

Health and quality of life outcomes, Vol.4(1), pp.24-24

03/31/2006

DOI: https://doi.org/10.1186/1477-7525-4-24

Handle:

https://hdl.handle.net/2376/110221

PMCID: PMC1526423

PMID: 16573839

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https://doi.org/10.1186/1477-7525-4-24View

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Abstract

Fentanyl - administration & dosage

Pain, Intractable - drug therapy

Pain, Intractable - etiology

Drug Administration Schedule

Administration, Oral

Fentanyl - therapeutic use

Humans

Analgesics, Opioid - pharmacology

Analgesics, Opioid - therapeutic use

Palliative Care

Fentanyl - pharmacology

Administration, Cutaneous

Buprenorphine - pharmacology

Dose-Response Relationship, Drug

Buprenorphine - administration & dosage

Algorithms

Buprenorphine - therapeutic use

Titrimetry - standards

Analgesics, Opioid - administration & dosage

Neoplasms - physiopathology

Patients with moderate to severe malignancy-related pain frequently require the use of opioid pharmacotherapy. Unfortunately, many cancer patients continue to be prescribed subtherapeutic doses of pain medications resulting in undo suffering and diminished quality of life. The choice of analgesic pharmacotherapy should be individualized and based on the intensity and etiology of pain reported by the patient. Health care providers must be able to readily quantify the relative analgesic potency when converting from one opioid to another or from one route of administration to another. Transdermal fentanyl is effective and well tolerated pharmacotherapy for the cancer pain patients. However, clinicians need to be cognizant that the U.S./U.K. manufacturer's recommendations for equilalagesic dosing of transdermal fentanyl may result in initial doses that produce subtherapeutic levels and unrelieved pain in some patients. A more aggressive dosing algorithm for transdermal fentanyl using a 2:1 (mg/day of oral morphine: mcg/hr of transdermal fentanyl) conversion ratio that considers both a review of the literature and clinical experience should help clinicians individualize cancer pain pharmacotherapy. Transdermal buprenorphine is now being prescribed in Europe and Australia for chronic and cancer pain management. Buprenorphine's mixed agonist/antagonist activity, dosage ceiling, and high affinity to the opiate receptor limits its use to those patients who do not already require large daily doses of opioids. Thus, buprenorphine may not be an appropriate medication for some patients with advanced unremitting cancer pain.

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Title: Transdermal opioids for cancer pain
Creators: Tracy L Skaer - College of Pharmacy, Washington State University, Wegner Hall Room 105, PO BOX 646510, Pullman, WA 99164-6510, USA. tskaer@wsu.edu
Publication Details: Health and quality of life outcomes, Vol.4(1), pp.24-24
Academic Unit: Pharmacotherapy, Department of
Publisher: England
Identifiers: 99900547783701842
Language: English
Resource Type: Journal article