Conversion ratios for opioid switching in the treatment of cancer pain

A systematic review

Sebastiano Mercadante, Augusto Caraceni

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

In this paper we describe the results of a systematic search of the literature on conversion ratios during opioid switching. This is part of a project of the European Palliative Care Research Collaboration to update the European Association for Palliative Care recommendations for the use of opioid analgesics in the treatment of cancer pain. Studies were eligible for inclusion if they involved adult patients with chronic cancer pain, contained data on opioid conversion ratios, were prospective and were written in English. Thirty-one studies were identified and included. The majority of the studies had methodological flaws and were not designed to explore or demonstrate equianalgesic dose data. However, the data allow some recommendations to be made that could be helpful to clinicians for whom there are few reliable experimental data on which to base dosing guidelines. Switching to transdermal fentanyl (TDfe) or buprenorphine (TDbu) is an option for patients with stable, controlled pain. Reliable and consistent studies show a ratio of 100 : 1 between oral morphine (ORmo) and TDfe. A ratio of 75 : 1 between ORmo and TDbu may be appropriate, but the supporting evidence here is much less robust. Data are relatively consistent to support a conversion ratio between ORmo and oral hydromorphone (ORhy) of 5 : 1. Despite some limitations, there is evidence to support the use of an approximate conversion ratio of ORmo:oral oxycodone (ORox) of 1.5 : 1. The conversion between ORox and ORhy is estimated to be 1 : 4. When switching from different opioids to methadone the conversion ratio is highly variable, ranging from 5 : 1 to 10 : 1 and much higher in some studies. The derived ratios are influenced by several factors, including the reasons for switching and previous opioid doses. An individual treatment decision and strict monitoring is recommended for patients considered at risk.

Original languageEnglish
Pages (from-to)504-515
Number of pages12
JournalPalliative Medicine
Volume25
Issue number5
DOIs
Publication statusPublished - Jul 2011

Fingerprint

Opioid Analgesics
Morphine
Hydromorphone
Oxycodone
Buprenorphine
Fentanyl
Palliative Care
Therapeutics
Methadone
Chronic Pain
Cancer Pain
Guidelines
Pain
Research

Keywords

  • conversion ratio
  • Neoplasm
  • opioids
  • pain
  • switching rotation

ASJC Scopus subject areas

  • Medicine(all)
  • Anesthesiology and Pain Medicine

Cite this

Conversion ratios for opioid switching in the treatment of cancer pain : A systematic review. / Mercadante, Sebastiano; Caraceni, Augusto.

In: Palliative Medicine, Vol. 25, No. 5, 07.2011, p. 504-515.

Research output: Contribution to journalArticle

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