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Oncology (Williston Park). 2005 Apr;19(4):511-6; discussion 516-8, 521-3, 527-8.

Opioid rotation in cancer patients: pros and cons.

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The Harry R. Horvitz Center for Palliative Medicine, The Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.


Opioid rotation involves changing from one opioid to another using correct equianalgesic conversion techniques to achieve better analgesia and/or fewer side effects. The strategy appears to work because of significant interindividual variations in response to both analgesic activity and toxicity. Although there are many retrospective studies, few prospective controlled trials of opioid rotation have been published. The practical and theoretical advantages of opioid rotation include improved analgesia, reduced side effects, cost reduction, and improved compliance. Disadvantages include problems related to inaccurate conversion tables, limited availability of certain opioid formulations, drug interactions, and the possibility of increased expense. Weighing the advantages and disadvantages is essential prior to making a decision about opioid rotation selection.

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