Thursday, July 28, 2005

Transdermal fentanyl to methadone conversion

The current J of Clinical Oncology has a nice little article about one group's experience converting TTS fentanyl to methadone or vice versa.  They chose an ratio of fentanyl to methadone of 1:20 [eg 175mcg/h of TTS fentanyl = 4.2mg fentanyl/24hrs = 84mg methadone/24h] &, to make a long story short, had pretty good luck with this as a starting conversion ratio (these were inpatients whose pain was actively managed during the conversion).  The article is also an argument for opioid rotation:  the patients in the study were all switched because of inadequate analgesia and most of them achieve significantly better analgesia with the opioid switch (in either direction). 

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