What are the indications for opioid rotation?

Updated: Jan 29, 2018
  • Author: Stephen Kishner, MD, MHA; Chief Editor: Erik D Schraga, MD  more...
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  • Unmanageable side effects during dose titration

  • Poor analgesia despite dose titration

  • Alternate route of administration needed

  • Change in clinical status requires different pharmacokinetics (eg, renal insufficiency or hepatic dysfunction)

  • Cost or financial considerations

  • Drug availability issues

  • Interactions between drugs

  • Most commonly done for poor opioid responsiveness

  • Specific mechanisms by which it improves overall response is unknown; likely from large individual variation to different agents and the phenomenon of incomplete cross-tolerance

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