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Smith HS, Peppin JF. Toward a systematic approach to opioid rotation. J Pain Res. 2014;7:589-608doi: 10.2147/JPR.S55782.
Smith, H. S., & Peppin, J. F. (2014). Toward a systematic approach to opioid rotation. Journal of pain research, 7589-608. https://doi.org/10.2147/JPR.S55782
Smith, Howard S, and Peppin, John F. "Toward a systematic approach to opioid rotation." Journal of pain research vol. 7 (2014): 589-608. doi: https://doi.org/10.2147/JPR.S55782
Smith HS, Peppin JF. Toward a systematic approach to opioid rotation. J Pain Res. 2014 Oct 17;7:589-608. doi: 10.2147/JPR.S55782. eCollection 2014. PMID: 25378948; PMCID: PMC4207581.
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J Pain Res. 2014 Oct 17;7:589-608. doi: 10.2147/JPR.S55782. eCollection 2014.

Toward a systematic approach to opioid rotation.

Journal of pain research

Howard S Smith, John F Peppin

Affiliations

  1. Department of Anesthesiology, Albany Medical College, Albany, NY, USA.
  2. Global Scientific Affairs, Mallinckrodt Pharmaceuticals, St Louis, MO, USA ; Center for Bioethics, Pain Management and Medicine, St Louis, MO, USA.

PMID: 25378948 PMCID: PMC4207581 DOI: 10.2147/JPR.S55782

Abstract

Patients requiring chronic opioid therapy may not respond to or tolerate the first opioid prescribed to them, necessitating rotation to another opioid. They may also require dose increases for a number of reasons, including worsening disease and increased pain. Dose escalation to restore analgesia using the primary opioid may lead to increased adverse events. In these patients, rotation to a different opioid at a lower-than-equivalent dose may be sufficient to maintain adequate tolerability and analgesia. In published trials and case series, opioid rotation is performed either using a predetermined substitute opioid with fixed conversion methods, or in a manner that appears to be no more systematic than trial and error. In clinical practice, opioid rotation must be performed with consideration of individual patient characteristics, comorbidities (eg, concurrent psychiatric, pulmonary, renal, or hepatic illness), and concurrent medications, using flexible dosing protocols that take into account incomplete opioid cross-tolerance. References cited in this review were identified via a search of PubMed covering all English language publications up to May 21, 2013 pertaining to opioid rotation, excluding narrative reviews, letters, and expert opinion. The search yielded a total of 129 articles, 92 of which were judged to provide relevant information and subsequently included in this review. Through a review of this literature and from the authors' empiric experience, this review provides practical information on performing opioid rotation in clinical practice.

Keywords: chronic pain; opioid analgesics; opioid rotation

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