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Practical management of opioid rotation and equianalgesia

Authors Treillet E, Laurent S, Hadjiat Y

Received 5 April 2018

Accepted for publication 24 July 2018

Published 29 October 2018 Volume 2018:11 Pages 2587—2601


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Katherine Hanlon

Erwan Treillet,1 Sophie Laurent,2 Yacine Hadjiat3

1AP-HP, Médecine de la Douleur et Médecine Palliative, Hôpital Lariboisière, Paris, France; 2Institut de Cancérologie, Institut Gustave Roussy, Villejuif, France; 3Mundipharma France, Paris, France

Purpose: To review the recent literature on opioid rotation (ie, switching from one opioid drug to another or changing an opioid’s administration route) in cancer patients experiencing severe pain and to develop a novel equianalgesia table for use in routine clinical practice.
Methods: The MEDLINE database was searched with terms “cancer pain,” “opioid rotation,” “opioid switching,” “opioid ratio,” “opioid conversion ratio,” and “opioid equianalgesia” for the major opioids (morphine, oxycodone, fentanyl, and hydromorphone) and the intravenous, subcutaneous, oral, and transdermal administration routes. Selected articles were assessed for the calculated or cited opioid dose ratio, bidirectionality, and use of the oral morphine equivalent daily dose or a direct drug-to-drug ratio.
Results: Twenty publications met our selection criteria and were analyzed in detail. We did not find any large-scale, prospective, double-blind randomized controlled trial with robust design, and most of the studies assessed relatively small numbers of patients. Bidirectionality was investigated in seven studies only.
Conclusion: The updated equianalgesic table presented here incorporates the latest data and provides information on bidirectionality. Despite the daily use of equianalgesic tables, they are not based on high-level scientific evidence. More clinical research is needed on this topic.

Keywords: opioid rotation, opioid switching, equianalgesic dose, morphine, hydromorphone, oxycodone, fentanyl

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