Opioid Rotation to Alternative Strong Opioids in Cancer Patients Experiencing Untolerable Side Effects

Background: According to the WHO analgesic ladder, opioids are the mainstay of cancer pain management. Oral morphine has been used in treating cancer pain of moderate to severe intensity. However, a significant proportion-of patients under oral morphine do not have successful outcomes, often switched to alternative strong opioids. Opioid rotation is a therapeutic maneuver aiming in improving side effects. Opioid rotation be useful in opening the therapeutic window and have a more advantageous analgesia/toxicity relationship. However, too much work is to be done to further individualize analgesic therapy for patients with cancer. This work was planned to compare opioid shifting results from morphine to hydromorphone, oxycodone and fentanyl regarding side effects in cancer pain patients. Patients and Methods: The patients who were under the effect of basal controlled dose of sustained release MST tablets will be chosen from the study. They were under the effects of controlled treatment for 4 weeks or more. After that the cases of patients who revealed untolerable side effects (with a special reference to neurotoxic side effects) despite controlled treatment would be picked up for the study for further investigation. For statistical purpose we chosed 390 cases for our study. The patients divided in 3 main groups; each group consists of 130 patients: •Group 1: Switchers to oxycodone (13 0 patients) (in the form of tablets). •Group 2: Switchers to hydromorphone (13 0 patients) (in the form of tablets). •Group 3: Switchers to fentanyl (13 0 patients) (in the form of patches). The control value of each patient would be his situation at the time of shifting. Results: Regarding nausea and vomiting significant improvement for fentanyl group versus oxycodone and hydro-morphone group. Conclusion: In this study, we conclude that patients switched to transdermal fentanyl improved nausea, vomiting, constipation and kidney function (improved serum creatinine and serum uric acid).