Mercadante, S., Ferrera, P., Villari, P., & Casuccio, A. (2005). Rapid switching between transdermal fentanyl and methadone in cancer patients. Journal of Clinical Oncology, 23, 5229–5234.

To evaluate whether patients on either transdermal fentanyl or oral methadone required switching opioid therapy because of ineffective analgesia or adverse effects

The ratio between patients receiving fentanyl and methadone was 1:20. Patients who started with fentanyl patches and were switched to oral methadone had the patch removed with the first dose of methadone (n = 24). Patients who started on oral methadone and were switched to patches received the patch immediately after the last dose of methadone (n = 7). Rescue doses of oral or IV morphine were given using 1/6 of the daily dose.

The study consisted of 31 consecutive patients admitted to an acute palliative care unit for a one-year period.

The study was conducted in an acute palliative care unit in Italy.

This was a prospective study.

A switch was considered successful when the pain intensity or distress score decreased by at least 33%.

Eighteen patients benefited from switching, as confirmed by significant changes in pain intensity and distress scores. In those who switched from fentanyl to methadone, the mean time to dose stabilization was 4.3 days. In those who switched from methadone to fentanyl, mean time to stabilization was 2 days. The switch was considered unsuccessful In six patients.

• Few patients switched from methadone to fentanyl.
• The sample size was small.
• Studying patients undergoing palliative care in critical conditions can be difficult because of complex contexts.

Rapid titrations need to be closely monitored in an acute care setting.