Switching from high doses of pure μ-opioid agonists to transdermal buprenorphine in patients with cancer: a feasibility study
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Switching from high doses of pure μ-opioid agonists to transdermal buprenorphine in patients with cancer : a feasibility study. / Lundorff, Lena; Sjøgren, Per; Hansen, Ole Bo; Jonsson, Torsten; Nielsen, Per Rotbøll; Christrup, Lona Louring.
In: Journal of Opioid Management, Vol. 9, No. 4, 20.12.2013, p. 255-62.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Switching from high doses of pure μ-opioid agonists to transdermal buprenorphine in patients with cancer
T2 - a feasibility study
AU - Lundorff, Lena
AU - Sjøgren, Per
AU - Hansen, Ole Bo
AU - Jonsson, Torsten
AU - Nielsen, Per Rotbøll
AU - Christrup, Lona Louring
PY - 2013/12/20
Y1 - 2013/12/20
N2 - BACKGROUND: Several myths on buprenorphine's pharmacology exist: possible analgesic ceiling effect, feasibility of combination with other opioid agonists, and the reversibility of side effects. Aim to evaluate: 1) if cancer patients receiving high doses of pure agonists could obtain adequate pain relief after switching to transdermal (TD) buprenorphine and 2) whether the numbers of breakthrough pain episodes after switching increased and whether they could be treated with the same doses of pure agonist as before switching.DESIGN: The prospective open multicenter study included outpatients with moderate-to-severe cancer pain satisfactorily controlled.SETTING: Patients were switched from the usual pure agonist to TD buprenorphine and were titrated to a stable dose. The assessments were: 1) daily self-assessment of pain intensity, numbers of rescue medications, and pain interference with sleep; 2) brief pain inventory; 3) pain relief and pain intensity; 4) quality of life; and 5) adverse events and symptoms.RESULTS: Eighteen patients receiving 150-516 mg of morphine/day were included. The buprenorphine dose at the end of the study varied between 52.5 and 140 μg/h. No difference in pain before and after switching was shown. The level of rescue doses was maintained. The patches were well tolerated. A significant decrease in fatigue and an increase in global health status were seen after the switch.CONCLUSION: It is feasible to switch cancer patients from high doses of pure μ-opioid agonists to TD buprenorphine without eliciting any antagonist effects, but the dose conversion factor is individual and the switching process should be tailored for the individual patient.
AB - BACKGROUND: Several myths on buprenorphine's pharmacology exist: possible analgesic ceiling effect, feasibility of combination with other opioid agonists, and the reversibility of side effects. Aim to evaluate: 1) if cancer patients receiving high doses of pure agonists could obtain adequate pain relief after switching to transdermal (TD) buprenorphine and 2) whether the numbers of breakthrough pain episodes after switching increased and whether they could be treated with the same doses of pure agonist as before switching.DESIGN: The prospective open multicenter study included outpatients with moderate-to-severe cancer pain satisfactorily controlled.SETTING: Patients were switched from the usual pure agonist to TD buprenorphine and were titrated to a stable dose. The assessments were: 1) daily self-assessment of pain intensity, numbers of rescue medications, and pain interference with sleep; 2) brief pain inventory; 3) pain relief and pain intensity; 4) quality of life; and 5) adverse events and symptoms.RESULTS: Eighteen patients receiving 150-516 mg of morphine/day were included. The buprenorphine dose at the end of the study varied between 52.5 and 140 μg/h. No difference in pain before and after switching was shown. The level of rescue doses was maintained. The patches were well tolerated. A significant decrease in fatigue and an increase in global health status were seen after the switch.CONCLUSION: It is feasible to switch cancer patients from high doses of pure μ-opioid agonists to TD buprenorphine without eliciting any antagonist effects, but the dose conversion factor is individual and the switching process should be tailored for the individual patient.
KW - Administration, Cutaneous
KW - Adult
KW - Aged
KW - Analgesics, Opioid
KW - Analysis of Variance
KW - Breakthrough Pain
KW - Buprenorphine
KW - Chronic Pain
KW - Denmark
KW - Drug Substitution
KW - Feasibility Studies
KW - Female
KW - Humans
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Neoplasms
KW - Odds Ratio
KW - Pain Measurement
KW - Prospective Studies
KW - Quality of Life
KW - Questionnaires
KW - Receptors, Opioid, mu
KW - Transdermal Patch
KW - Treatment Outcome
U2 - 10.5055/jom.2013.0166
DO - 10.5055/jom.2013.0166
M3 - Journal article
C2 - 24353018
VL - 9
SP - 255
EP - 262
JO - Journal of Opioid Management
JF - Journal of Opioid Management
SN - 1551-7489
IS - 4
ER -
ID: 129174044