Opioid rotation

In palliative medicine and pain therapy, the term opiate rotation or opioid change is an exchange of the opioid used because of insufficient effectiveness or significant side effects.

Since pain therapy with opioids is often started with morphine , the most common change from morphine to fentanyl , hydromorphone , oxycodone or buprenorphine is part of the opioid rotation . When switching from one opioid to the other, equivalent doses are usually used; only in the case of very high doses is the therapy often continued with a dose lower than the equivalent dose in order to avoid an acute overdose. In these cases, inpatient monitoring of the conversion phase can be useful.

In a broader sense, switching between different preparations for other reasons can also be viewed as opioid rotation, e.g. B. the exchange of morphine tablets for a fentanyl pain plaster because of a swallowing disorder or lack of therapy compliance on the part of the patient.

literature

• R. Chou, GJ Fanciullo, PG Fine PG et al: APS / AAPM Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. In: J Pain. 2009 (Feb); 10 (2), pp. 113-130.