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).
For more
Pallimed posts about opioids.
For more
Pallimed posts by Dr. Rosielle click here.
Drew Rosielle, MD is a palliative care physician at the University of Minnesota Health in Minnesota. He founded Pallimed in 2005. You can occasionally find him on Twitter at @drosielle.
