Module 4: Therapeutics

Lesson 4

Learning outcome

Articulate approaches to trials, tapering, and rotation of CDS in therapeutic management of pain, anxiety, insomnia, and ADHD.

Opioid rotation

Opioid rotation may be necessary when patients experience adverse effects, develop a tolerance to one opioid with subsequent loss of beneficial effects, or before beginning an opioid taper when rotation is indicated.

There is incomplete and relatively unpredictable cross tolerance between opioids, so dose reduction is necessary from equivalent total daily dose. Below are recommendations for adjusting dosages:

• If the previous dose was high, convert 50% of the dose.
• If the previous dose was moderate or low, convert 60–75% of the dose.

Converting to and from fentanyl is complex and consultation with clinical experts and pharmacy colleagues is mandatory.