RT Journal Article
SR Electronic
T1 Transdermal fentanyl to parenteral morphine route switch and drug rotation in refractory cancer cachexia
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP bmjspcare-2019-001935
DO 10.1136/bmjspcare-2019-001935
A1 Samy A Alsirafy
A1 Saad H Alabdullateef
A1 Ashraf M Elyamany
A1 Amneh D Hassan
A1 Mohammed Almashiakhi
YR 2019
UL http://spcare.bmj.com/content/early/2019/09/05/bmjspcare-2019-001935.abstract
AB 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.