{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:45:40Z","timestamp":1785426340372,"version":"3.56.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,6,5]],"date-time":"2020-06-05T00:00:00Z","timestamp":1591315200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Opioid rotation from transdermal fentanyl to an alternate opioid is often necessitated in advanced disease, but is fraught with uncertainty due to variable absorption from the patch in end-stage illness and the lack of a clearly established opioid rotation ratio. The manufacturer of transdermal fentanyl provides opioid rotation recommendations only for rotation from the oral morphine equivalent daily dose (MEDD) of opioid to the patch, not in the opposite direction. This is a case report of a single patient with cancer and cachexia admitted to the palliative care unit of a large academic medical centre in Canada. The patient is a 50-year-old female with widely metastatic breast cancer who developed opioid toxicity when maintenance transdermal fentanyl patch therapy (100\u2009\u03bcg patch applied every 72\u2009h) was rotated to subcutaneous hydromorphone infusion to improve pain control. Hydromorphone was initiated at a rate of 1\u2009mg\/h by continuous infusion based on an opioid rotation ratio for transdermal fentanyl (\u03bcg\/h):MEDD (mg\/day) of 1:2.4. Opioid toxicity eventually resolved with downward titration of hydromorphone to only 30% of the initially estimated equianalgesic dose. This case highlights the need for close follow-up of all patients undergoing opioid rotation from transdermal fentanyl and reinforces the need to reduce the initial dose of the new opioid by 30%\u201350% of the calculated MEDD, especially when rotating from a high dose of transdermal fentanyl, or if there are factors potentially impairing absorption from the patch such as age, cachexia and weight loss, or if rotation is performed for reasons other than uncontrolled pain.<\/jats:p>","DOI":"10.1177\/1078155220929415","type":"journal-article","created":{"date-parts":[[2020,6,5]],"date-time":"2020-06-05T09:27:27Z","timestamp":1591349247000},"page":"238-243","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Opioid rotation from transdermal fentanyl to continuous subcutaneous hydromorphone in a cachectic patient: A case report and review of the literature"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3723-6637","authenticated-orcid":false,"given":"Lawrence D","family":"Jackson","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada"},{"name":"Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Wortzman","sequence":"additional","affiliation":[{"name":"Division of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Selby","sequence":"additional","affiliation":[{"name":"Division of Family & Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,6,5]]},"reference":[{"key":"bibr1-1078155220929415","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2009.04.012"},{"key":"bibr2-1078155220929415","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(00)00258-8"},{"key":"bibr3-1078155220929415","doi-asserted-by":"publisher","DOI":"10.2147\/JPR.S170269"},{"key":"bibr4-1078155220929415","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2007.12.024"},{"key":"bibr5-1078155220929415","doi-asserted-by":"publisher","DOI":"10.1097\/01.ftd.0000160717.50704.42"},{"key":"bibr6-1078155220929415","unstructured":"Sandoz Fentanyl Patch\u00ae; Fentanyl Transdermal System (Matrix-based system) [product monograph] Sandoz Canada Inc. 110 Rue de Lauzon, Boucherville, Quebec, Canada J4B 1E6. 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