Aim of investigation: Opioid rotation/switching (OR) is increasingly used in clinical practice. The rate for OR in palliative care has been documented in several studies between 20 and 44%. Aim of this prospective study was to compare frequency, indication and dose ratio of OR in ambulatory and stationary palliative care.
Methods: A prospective study was carried out on 415 palliative care patients treated between may and august 2002 with strong opioids (WHO step III). Reasons for OR were analysed in relation to analgesic efficacy, side effects, application problems. Dose ratios were calculated. On the base of these data a critical evaluation for the OR decisions was made.
Results: OR included morphine, fentanyl, oxycodone, hydromorphone and lmethadone. OR was found in 31% of the documented cases. In 15% a combination of more then one opioid was found. The frequency for OR in the stationary setting was higher (41%) than in the ambulatory setting (28%). Considering interindividual variability in response to various opioids no sound evidence of the superiority of the first line opioid over another was found though there were intraindividual differences in analgesic efficacy, side effects and application compliance after OR.
Conclusions: Further clinical studies on the specific features of the different opioids must be made before recommendations can be given on an evidenced base. Acknowledgement: The study was sponsored by Mundipharma, Limburg, Germany.