The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
Eduardo Bruera - One of the best experts on this subject based on the ideXlab platform.
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switching from methadone to a different opioid what is the Equianalgesic dose ratio
Journal of Palliative Medicine, 2008Co-Authors: Paul Walker, Shana L Palla, Guddi Kaur, Karen Zhang, Jeanine Hanohano, Mark F Munsell, Eduardo BrueraAbstract:Abstract Introduction: Methadone (ME) is a highly effective opioid agonist used for difficult pain syndromes. However, in the management of cancer pain with strong opioids, rotation to a different opioid (opioid rotation) may be required because of side effects or poor pain control. Rotation from methadone to another opioid has received limited study and therefore may be difficult because of the absence of a uniformly accepted dose conversion ratio. Methods: Retrospectively reviewed consecutive medical records of patients undergoing an opioid rotation from methadone to an alternative opioid were evaluated. For inclusion, patients were required to have received methadone for at least 3 days and have reached stable dose of the alternative opioid(s) during the 7 days following. Stable dose was defined as a 30% or less change in opioid dose from one day to the next. Results: Records of 39 patients met inclusion criteria. Excluded from analysis were 5 patients who were restarted on methadone within 7 days, 2 w...
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switching from methadone to a different opioid what is the Equianalgesic dose ratio
Journal of Clinical Oncology, 2006Co-Authors: Paul Walker, Eduardo Bruera, Shana L Palla, Guddi Kaur, Karen Zhang, H Jeanine, Eardie Curry, M MansellAbstract:8617 Background: Methadone (ME) is a highly effective opioid agonist used for difficult pain syndromes. However, the rotation from ME to another opioid may be difficult because of the absence of a ...
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Equianalgesic dose ratios for opioids a critical review and proposals for long term dosing
Journal of Pain and Symptom Management, 2001Co-Authors: Jose Pereira, Peter G Lawlor, Antonio Vigano, Marlene Dorgan, Eduardo BrueraAbstract:Clinicians involved in the opioid pharmacotherapy of cancer-related pain should be acquainted with a variety of opioids and be skilled in the selection of doses when the type of opioid or route of administration needs changing. The optimal dose should avoid under-dosing or overdosing, both associated with negative outcomes for the patient. Although Equianalgesic dose tables are generally used to determine the new doses in these circumstances, the evidence to support the ratios indicated in these tables largely refers to the context of single dose administration. The applicability of these ratios to the setting of chronic opioid administration has been questioned. A systematic search of published literature from 1966 to September 1999 was conducted to critically appraise the emerging evidence on Equianalgesic dose ratios derived from studies of chronic opioid administration. There were six major findings: 1) there exists a general paucity of data related to long-term dosing and studies are heterogeneous in nature; 2) the ratios exhibit extremely wide ranges; 3) methadone is more potent than previously appreciated; 4) the ratios related to methadone are highly correlated with the dose of the previous opioid; 5) the ratio may change according to the direction the opioid switch; and 6) discrepancies exist with respect to both oxycodone and fentanyl. Overall, these findings have important clinical implications for clinicians and warrant consideration in the potential revision of current tables. The complexity of the clinical context in which many switches occur must be recognized and also appreciated in the design of future studies.
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Equianalgesic dose/ratio between methadone and other opioid agonists in cancer pain: Comparison of two clinical experiences
Annals of Oncology, 1998Co-Authors: C Ripamonti, L Groff, F De Conno, M Belzile, Jose Pereira, John Hanson, Eduardo BrueraAbstract:Summary Background Oral methadone is considered to be a valid opioid analgesic alternative to morphine and hydromorphone in treating cancer pain. However, the use of methadone could be complicated by the limited knowledge of the Equianalgesic dose/ratio with the other analgesic opioids when switching in tolerant patients. Patients and methods In two Palliative Care Units, data collected regarding 88 advanced cancer patients with pain switched from different opioids to oral methadone were reviewed and compared with the aim of determining the Equianalgesic dose ratio in relation to the dose of opioid previously administered. Results The results of this retrospective study suggest that: (1) methadone is much more potent than previously described in literature, (2) the dose ratio between hydromorphone and methadone is higher than as suggested by Equianalgesic tables, and (3) the ratio correlates with total opioid dose administered before switching. Conclusions The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover. Prospective studies should be carried out in order to better define our findings.
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dose ratio between morphine and methadone in patients with cancer pain a retrospective study
Cancer, 1998Co-Authors: Peter G Lawlor, John Hanson, Kenneth Turner, Eduardo BrueraAbstract:BACKGROUND Current Equianalgesic reference tables, based largely on single dose studies, give dose ratios of 1:1 to 4:1 for oral morphine to oral methadone, which possibly are inaccurate in patients with cancer pain who are exposed to multiple doses of these opioids. The purpose of this study was to determine the Equianalgesic dose ratio between morphine and methadone in patients with cancer pain and to establish whether the dose ratio changes as a function of previous opioid dose. METHODS A retrospective analysis of consecutive rotations involving morphine and methadone using standard selection criteria identified a total of 20 evaluable rotations (14 from morphine to methadone and 6 from methadone to morphine). Opioid doses and pain intensity levels pre- and postrotation were analyzed. RESULTS Median dose ratios (lower-upper quartiles) for morphine to methadone and methadone to morphine rotations were 11.36 (range, 5.98-16.27) and 8.25 (range, 4.37-11.3), respectively (P = 0.23). Combining all 20 rotations, a unified median dose ratio of 11.2 (range, 5.06-13.24) was calculated. There was no significant difference in pain intensity levels pre- and postrotation as recorded on a visual analogue scale. Univariate correlational analysis of dose ratio and the level of daily morphine dose prior to rotation revealed a Spearman correlation coefficient of 0.86 (P = 0.0001). In patients receiving >1165 mg per day prior to methadone rotation, a median dose ratio of 16.84 (range, 12.25-87.95) was observed, which was approximately 3 times higher compared with a median dose ratio of 5.42 (range, 2.95-9.09) (P = 0.007) for the 50% of patients receiving lower morphine doses. CONCLUSIONS The results highlight the general underestimation of methadone potency and the consequent risk of potential life-threatening toxicity. The strongly positive correlation between dose ratio and previous morphine dose suggests the need for a highly individualized and cautious approach when rotating from morphine to methadone in patients with cancer pain. Cancer 1998;82:1167-73. © 1998 American Cancer Society.
F De Conno - One of the best experts on this subject based on the ideXlab platform.
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switching from morphine to oral methadone in treating cancer pain what is the Equianalgesic dose ratio
Journal of Clinical Oncology, 1998Co-Authors: C Ripamonti, L Groff, Cinzia Brunelli, D Polastri, A Stavrakis, F De ConnoAbstract:PURPOSETo define the dose ratio between morphine and methadone in relation to the previous morphine dose and the number of days needed to achieve the same level of analgesia in a group of patients with advanced cancer with pain who switched from morphine to oral methadone.PATIENTS AND METHODSA cross-sectional prospective study of 38 consecutive cancer patients who switched from morphine to oral methadone was performed. The intensity of pain before, during, and after the switching period was assessed through a four-point verbal Likert scale. The relationship between previous morphine dose and the final Equianalgesic methadone dose, dose ratio between morphine and methadone, and the number of days required to achieve equianalgesia have been examined by means of Pearson's correlation coefficient, scatter plots, and Cuzick's test for trend respectively.RESULTSBefore the switch, the median oral equivalent daily dose of morphine was 145 mg/d; after the switch, the median Equianalgesic oral methadone dose was 21...
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Equianalgesic dose/ratio between methadone and other opioid agonists in cancer pain: Comparison of two clinical experiences
Annals of Oncology, 1998Co-Authors: C Ripamonti, L Groff, F De Conno, M Belzile, Jose Pereira, John Hanson, Eduardo BrueraAbstract:Summary Background Oral methadone is considered to be a valid opioid analgesic alternative to morphine and hydromorphone in treating cancer pain. However, the use of methadone could be complicated by the limited knowledge of the Equianalgesic dose/ratio with the other analgesic opioids when switching in tolerant patients. Patients and methods In two Palliative Care Units, data collected regarding 88 advanced cancer patients with pain switched from different opioids to oral methadone were reviewed and compared with the aim of determining the Equianalgesic dose ratio in relation to the dose of opioid previously administered. Results The results of this retrospective study suggest that: (1) methadone is much more potent than previously described in literature, (2) the dose ratio between hydromorphone and methadone is higher than as suggested by Equianalgesic tables, and (3) the ratio correlates with total opioid dose administered before switching. Conclusions The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover. Prospective studies should be carried out in order to better define our findings.
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Equianalgesic dose ratio between methadone and other opioid agonists in cancer pain comparison of two clinical experiences
Annals of Oncology, 1998Co-Authors: C Ripamonti, L Groff, F De Conno, M Belzile, Jose Pereira, John Hanson, Eduardo BrueraAbstract:Summary Background Oral methadone is considered to be a valid opioid analgesic alternative to morphine and hydromorphone in treating cancer pain. However, the use of methadone could be complicated by the limited knowledge of the Equianalgesic dose/ratio with the other analgesic opioids when switching in tolerant patients. Patients and methods In two Palliative Care Units, data collected regarding 88 advanced cancer patients with pain switched from different opioids to oral methadone were reviewed and compared with the aim of determining the Equianalgesic dose ratio in relation to the dose of opioid previously administered. Results The results of this retrospective study suggest that: (1) methadone is much more potent than previously described in literature, (2) the dose ratio between hydromorphone and methadone is higher than as suggested by Equianalgesic tables, and (3) the ratio correlates with total opioid dose administered before switching. Conclusions The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover. Prospective studies should be carried out in order to better define our findings.
C Ripamonti - One of the best experts on this subject based on the ideXlab platform.
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switching from morphine to oral methadone in treating cancer pain what is the Equianalgesic dose ratio
Journal of Clinical Oncology, 1998Co-Authors: C Ripamonti, L Groff, Cinzia Brunelli, D Polastri, A Stavrakis, F De ConnoAbstract:PURPOSETo define the dose ratio between morphine and methadone in relation to the previous morphine dose and the number of days needed to achieve the same level of analgesia in a group of patients with advanced cancer with pain who switched from morphine to oral methadone.PATIENTS AND METHODSA cross-sectional prospective study of 38 consecutive cancer patients who switched from morphine to oral methadone was performed. The intensity of pain before, during, and after the switching period was assessed through a four-point verbal Likert scale. The relationship between previous morphine dose and the final Equianalgesic methadone dose, dose ratio between morphine and methadone, and the number of days required to achieve equianalgesia have been examined by means of Pearson's correlation coefficient, scatter plots, and Cuzick's test for trend respectively.RESULTSBefore the switch, the median oral equivalent daily dose of morphine was 145 mg/d; after the switch, the median Equianalgesic oral methadone dose was 21...
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Equianalgesic dose/ratio between methadone and other opioid agonists in cancer pain: Comparison of two clinical experiences
Annals of Oncology, 1998Co-Authors: C Ripamonti, L Groff, F De Conno, M Belzile, Jose Pereira, John Hanson, Eduardo BrueraAbstract:Summary Background Oral methadone is considered to be a valid opioid analgesic alternative to morphine and hydromorphone in treating cancer pain. However, the use of methadone could be complicated by the limited knowledge of the Equianalgesic dose/ratio with the other analgesic opioids when switching in tolerant patients. Patients and methods In two Palliative Care Units, data collected regarding 88 advanced cancer patients with pain switched from different opioids to oral methadone were reviewed and compared with the aim of determining the Equianalgesic dose ratio in relation to the dose of opioid previously administered. Results The results of this retrospective study suggest that: (1) methadone is much more potent than previously described in literature, (2) the dose ratio between hydromorphone and methadone is higher than as suggested by Equianalgesic tables, and (3) the ratio correlates with total opioid dose administered before switching. Conclusions The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover. Prospective studies should be carried out in order to better define our findings.
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Equianalgesic dose ratio between methadone and other opioid agonists in cancer pain comparison of two clinical experiences
Annals of Oncology, 1998Co-Authors: C Ripamonti, L Groff, F De Conno, M Belzile, Jose Pereira, John Hanson, Eduardo BrueraAbstract:Summary Background Oral methadone is considered to be a valid opioid analgesic alternative to morphine and hydromorphone in treating cancer pain. However, the use of methadone could be complicated by the limited knowledge of the Equianalgesic dose/ratio with the other analgesic opioids when switching in tolerant patients. Patients and methods In two Palliative Care Units, data collected regarding 88 advanced cancer patients with pain switched from different opioids to oral methadone were reviewed and compared with the aim of determining the Equianalgesic dose ratio in relation to the dose of opioid previously administered. Results The results of this retrospective study suggest that: (1) methadone is much more potent than previously described in literature, (2) the dose ratio between hydromorphone and methadone is higher than as suggested by Equianalgesic tables, and (3) the ratio correlates with total opioid dose administered before switching. Conclusions The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover. Prospective studies should be carried out in order to better define our findings.
Jose Pereira - One of the best experts on this subject based on the ideXlab platform.
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Equianalgesic dose ratios for opioids a critical review and proposals for long term dosing
Journal of Pain and Symptom Management, 2001Co-Authors: Jose Pereira, Peter G Lawlor, Antonio Vigano, Marlene Dorgan, Eduardo BrueraAbstract:Clinicians involved in the opioid pharmacotherapy of cancer-related pain should be acquainted with a variety of opioids and be skilled in the selection of doses when the type of opioid or route of administration needs changing. The optimal dose should avoid under-dosing or overdosing, both associated with negative outcomes for the patient. Although Equianalgesic dose tables are generally used to determine the new doses in these circumstances, the evidence to support the ratios indicated in these tables largely refers to the context of single dose administration. The applicability of these ratios to the setting of chronic opioid administration has been questioned. A systematic search of published literature from 1966 to September 1999 was conducted to critically appraise the emerging evidence on Equianalgesic dose ratios derived from studies of chronic opioid administration. There were six major findings: 1) there exists a general paucity of data related to long-term dosing and studies are heterogeneous in nature; 2) the ratios exhibit extremely wide ranges; 3) methadone is more potent than previously appreciated; 4) the ratios related to methadone are highly correlated with the dose of the previous opioid; 5) the ratio may change according to the direction the opioid switch; and 6) discrepancies exist with respect to both oxycodone and fentanyl. Overall, these findings have important clinical implications for clinicians and warrant consideration in the potential revision of current tables. The complexity of the clinical context in which many switches occur must be recognized and also appreciated in the design of future studies.
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Equianalgesic dose/ratio between methadone and other opioid agonists in cancer pain: Comparison of two clinical experiences
Annals of Oncology, 1998Co-Authors: C Ripamonti, L Groff, F De Conno, M Belzile, Jose Pereira, John Hanson, Eduardo BrueraAbstract:Summary Background Oral methadone is considered to be a valid opioid analgesic alternative to morphine and hydromorphone in treating cancer pain. However, the use of methadone could be complicated by the limited knowledge of the Equianalgesic dose/ratio with the other analgesic opioids when switching in tolerant patients. Patients and methods In two Palliative Care Units, data collected regarding 88 advanced cancer patients with pain switched from different opioids to oral methadone were reviewed and compared with the aim of determining the Equianalgesic dose ratio in relation to the dose of opioid previously administered. Results The results of this retrospective study suggest that: (1) methadone is much more potent than previously described in literature, (2) the dose ratio between hydromorphone and methadone is higher than as suggested by Equianalgesic tables, and (3) the ratio correlates with total opioid dose administered before switching. Conclusions The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover. Prospective studies should be carried out in order to better define our findings.
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Equianalgesic dose ratio between methadone and other opioid agonists in cancer pain comparison of two clinical experiences
Annals of Oncology, 1998Co-Authors: C Ripamonti, L Groff, F De Conno, M Belzile, Jose Pereira, John Hanson, Eduardo BrueraAbstract:Summary Background Oral methadone is considered to be a valid opioid analgesic alternative to morphine and hydromorphone in treating cancer pain. However, the use of methadone could be complicated by the limited knowledge of the Equianalgesic dose/ratio with the other analgesic opioids when switching in tolerant patients. Patients and methods In two Palliative Care Units, data collected regarding 88 advanced cancer patients with pain switched from different opioids to oral methadone were reviewed and compared with the aim of determining the Equianalgesic dose ratio in relation to the dose of opioid previously administered. Results The results of this retrospective study suggest that: (1) methadone is much more potent than previously described in literature, (2) the dose ratio between hydromorphone and methadone is higher than as suggested by Equianalgesic tables, and (3) the ratio correlates with total opioid dose administered before switching. Conclusions The fact that methadone ratio is different according to the opioid dose used previously should be taken into careful consideration by the clinician in order to avoid severe toxicity or death during switchover. Prospective studies should be carried out in order to better define our findings.
Mary Lynn Mcpherson - One of the best experts on this subject based on the ideXlab platform.
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why Equianalgesic tables are only part of the answer to equianalgesia
Annals of palliative medicine, 2020Co-Authors: Mary Lynn McphersonAbstract:: Opioids are an important tool in the management of acute and chronic (cancer and non-cancer) pain. Pain and palliative care practitioners are frequently called upon to switch a patient from one opioid regimen to a different regimen either to gain better pain control, to minimize opioid-related adverse effects, to overcome opioid tolerance, or due to a change in patient status. To this end, Equianalgesic tables have been published to guide practitioners in making these calculations. Despite being built on the best data available, Equianalgesic tables do not tell the whole story, requiring the practitioner to thoroughly consider the patient's situation, and unknown variables. A five-step process is presented in this article that espouse a safe and effective way to switch from one opioid regimen to another. Directions for the future include better refinement of the data that informs the Equianalgesic table, and perhaps inclusion of opioid utility data.
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clinical application of opioid Equianalgesic data
The Clinical Journal of Pain, 2003Co-Authors: Arnold R Gammaitoni, Mary Lynn Mcpherson, Perry G. Fine, Nancy A Alvarez, Suzette BergmarkAbstract:: Physicians and other healthcare professionals may often be faced with the need to change opioids during the course of a patient's opioid analgesic care due to a number of clinical reasons. The act of converting opioid analgesics, for many physicians, nurses, and pharmacists, who do not receive adequate training, remains a challenging and often uncomfortable aspect of pain treatment. Part of the challenge clinicians face is secondary to the relatively weak literature evidence base that exists to support the Equianalgesic ratios provided in textbooks, journals, and other medical resources. Another aspect involves the lack of a widely recognized treatment algorithm or guideline to assist clinicians with opioid conversion. The final decision on which opioid dose to prescribe must involve a thorough clinical assessment to minimize the risk of prescribing inappropriate opioid doses over or under the patient's actual need. The purpose of this paper is to provide the clinician with an approach for dealing with the conversion between opioid analgesics that is standardized, yet allows for individualized results to meet unique patient needs. We present a 5-step process as a guide for clinicians faced with the need to change a patient's opioid regimen. This approach may help to build a comfort level when dealing with the clinical challenges of converting from one opioid to another.