Intended for healthcare professionals


Dosing of opioids and other stories . . .

BMJ 2016; 352 doi: (Published 30 March 2016) Cite this as: BMJ 2016;352:i1725

Incalculable opioids

Every palliative care formulary contains equivalence charts for commonly used opioids such as morphine, oxycodone, buprenorphine, and fentanyl, the bedrock of pain control in cancer. Two new studies examined how dosing is applied in clinical practice. In the first, Italian oncologists conducted a multicentre trial using these four drugs in 520 patients (Ann Oncol doi: 10.1093/annonc/mdw097). Although they found similar patterns of efficacy, frequent changes of dosage were needed and a considerable proportion of patients did not respond to specific opioids. The second study was an electronic survey of 319 physicians, pharmacists, and nurse practitioners in the US who were asked to calculate equianalgesic doses of opioids, including hydromorphone, methadone, and the four already mentioned (Pain Med doi:10.1111/pme.12920). Large variations in calculation …

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