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Case report
Transdermal fentanyl to parenteral morphine route switch and drug rotation in refractory cancer cachexia
  1. Samy A Alsirafy1,2,
  2. Saad H Alabdullateef1,
  3. Ashraf M Elyamany3,4,
  4. Amneh D Hassan1 and
  5. Mohammed Almashiakhi3
  1. 1 Palliative Care Service, Hematology-Oncology Department, King Saud Medical City, Riyadh, Saudi Arabia
  2. 2 Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
  3. 3 Medical Oncology, Hematology-Oncology Department, King Saud Medical City, Riyadh, Saudi Arabia
  4. 4 Medical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
  1. Correspondence to Dr Samy A Alsirafy, Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt; alsirafy{at}kasralainy.edu.eg

Abstract

It is recommended not to use transdermal fentanyl (Fe) patches (TFP) in cancer cachexia but TFP may be the only available option for pain. Limited evidence suggests lower Fe absorption from TFP in cachexia. We describe a case of metastatic breast cancer with refractory cachexia. Her pain was uncontrolled on TFP and was route switched and drug rotated to intravenous morphine (M). We were conservative and did not use the 1:100 TFP to oral M conversion ratio. Assuming opioid needs were similar before and after switch/rotation, the suitable conversion ratio in this case was about 1:25. Absent clear guidelines on converting from TFP in cachexia, it is better to avoid TFP. When essential to use TFP in cachexia, caution should be taken when switching from TFP to avoid overdose.

  • Cancer
  • Cachexia
  • Fentanyl
  • Transdermal Patch

https://doi.org/10.1136/bmjspcare-2019-001935

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    Footnotes

    • Contributors SAA, SHA, ADH, AME and MA: Study design. SAA, SHA and ADH: Acquisition and analysis of data. SAA and SHA: Interpretation of data. SAA: Drafting the manuscript. SAA, SHA, ADH, AME and MA: Review and approval of the final version of the manuscript and agreement to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.