[Opioid switch and change of route of administration in cancer patients treated by morphine].

Abstract:

:This paper reviewed the 2002 guidelines established by the National Federation of Cancer Centres. A group of experts nominated by the 3 French Societies involved in the treatment of cancer pain (AFSOS, SFAP, SFETD), established new guidelines ratios for morphine switching and/or changing of route of administration, in patients for whom either pain was not adequatly managed or adverse effects were unbearable. After a rapid reminder of the pharmacokinetics and metabolism properties of morphine, experts explained why the theory of opioid rotation (oxycodone, hydromorphone, fentanyl, methadone, tapentadol) using fixed equianalgesic ratios is not any more appropriate for a secure clinical practice. In the light of recent publications enhancing our knowledge on the efficacy of new drug switching ratios and for changing the route of administration of morphine, the group of experts recommended to use reconsidered switching ratios favoring security upon efficacy, to minimize overdosing and adverse effects. Consequently, after the new conversion ratio (using slow release opioids) was applied, a second titration should be done by means of normal release rescue formulations for breakthrough pain episodes. A smartphone App. OpioConvert® will be available for rapid and secure dose conversions.

journal_name

Bull Cancer

journal_title

Bulletin du cancer

authors

Michenot N,Rostaing S,Baron L,Faure S,Jovenin N,Hubault P,Delorme T,Collin E,Filbet M,Chvetzoff G,Delorme C,Minello C,Magnet M,Ammar D,Krakowski I,Poulain P

doi

10.1016/j.bulcan.2018.06.011

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

1052-1073

issue

11

eissn

0007-4551

issn

1769-6917

pii

S0007-4551(18)30225-X

journal_volume

105

pub_type

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