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Text
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<a href="http://doi.org/10.1002/(SICI)1097-0142(19960815)78:4%3C852::AID-CNCR23%3E3.0.CO" target="_blank" rel="noreferrer">http://doi.org/10.1002/(SICI)1097-0142(19960815)78:4%3C852::AID-CNCR23%3E3.0.CO</a>
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Title
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Opioid rotation in patients with cancer pain. A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine
Publisher
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Cancer
Date
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1996
Subject
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Female; Humans; Male; Cohort Studies; Analgesics; Aged; Middle Aged; Drug Administration Schedule; 80 and over; Comparative Study; Administration; Oral; Pain/drug therapy/etiology; retrospective studies; Injections; Dose-Response Relationship; Drug; Hydromorphone/adverse effects/therapeutic use; Methadone/adverse effects/therapeutic use; Morphine/adverse effects/therapeutic use; Neoplasms/complications; Opioid/adverse effects/therapeutic use; Subcutaneous
Creator
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Bruera E; Pereira J; Watanabe S; Belzile M; Kuehn N; Hanson J
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<a href="http://doi.org/10.1002/(SICI)1097-0142(19960815)78:4%3C852::AID-CNCR23%3E3.0.CO" target="_blank" rel="noreferrer">10.1002/(SICI)1097-0142(19960815)78:4%3C852::AID-CNCR23%3E3.0.CO</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
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BACKGROUND. When a change of opioid is considered, equianalgesic dose tables are used. These tables generally propose a dose ratio of 5:1 between morphine and hydromorphone. In the case of a change from subcutaneous hydromorphone to methadone, dose ratios ranging from 1:6 to 1:10 are proposed. The purpose of this study was to review the analgesic dose ratios for methadone compared with hydromorphone. METHODS. In a retrospective study, 48 cases of medication changes from morphine to hydromorphone, and 65 changes between hydromorphone and methadone were identified. the reason for the change, the analgesic dose, and pain intensity were obtained. RESULTS. The dose ratios between morphine and hydromorphone and vice versa were found to be 5.33 and 0.28, respectively (similar to expected results). However, the hydromorphone/methadone ratio was found to be 1.14:1 (5 to 10 times higher than expected). Although the dose ratios of hydromorphone/morphine and vice versa did not change according to a previous opioid dose, the hydromorphone/methadone ratio correlated with total opioid dose (correlation coefficient = 0.41 P < 0.001) and was 1.6 (range, 0.3-14.4) in patients receiving more than 330 mg of hydromorphone per day prior to the change, versus 0.95 (range, 0.2-12.3) in patients receiving ae330 mg of hydromorphone per day (P = 0.023). CONCLUSIONS. These results suggest that only partial tolerance develops between methadone and hydromorphone. Methadone is much more potent than previously described and any change should start at a lower equivalent dose.
1996
80 And Over
Administration
Aged
Analgesics
Backlog
Belzile M
Bruera E
Cancer
Cohort Studies
Comparative Study
Dose-Response Relationship
Drug
Drug Administration Schedule
Female
Hanson J
Humans
Hydromorphone/adverse effects/therapeutic use
Injections
Journal Article
Kuehn N
Male
Methadone/adverse effects/therapeutic use
Middle Aged
Morphine/adverse effects/therapeutic use
Neoplasms/complications
Opioid/adverse effects/therapeutic use
Oral
Pain/drug therapy/etiology
Pereira J
Retrospective Studies
Subcutaneous
Watanabe S