Equianalgesic dose ratios for opioids: A critical review and proposals for long-term dosing
Equianalgesic dose ratios for opioids: A critical review and proposals for long-term dosing
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DOI：
10.1016/s0885-3924(01)00294-9
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发表时间：
2001-08-01
影响因子：
4.7
通讯作者：
Bruera, E
中科院分区：
文献类型：
--
作者：
Pereira, J;Lawlor, P;Bruera, E
参与癌症相关疼痛的阿片类药物治疗的临床医生应熟悉各种阿片类药物，并在阿片类药物的类型或给药途径需要改变时熟练地选择剂量。最佳剂量应避免剂量过少或过大，两者都与患者的负面结果相关。虽然在这些情况下，通常使用等量止痛剂量表来确定新的剂量，但支持这些表中所示比率的证据主要指的是单剂量给药。这些比率在慢性阿片类药物给药环境中的适用性受到质疑。对1966年至1999年9月发表的文献进行了系统的检索，以批判性地评价来自慢性阿片类药物给药研究的关于等止痛剂量比的新证据。有六个主要发现：1)普遍缺乏与长期服药有关的数据，研究本质上是不同的；2)比率显示出极大的范围；3)美沙酮比以前所认识的更有效；4)与美沙酮有关的比率与先前阿片类药物的剂量高度相关；5)比率可能根据阿片类药物转换的方向而改变；以及6)羟考酮和芬太尼都存在差异。总体而言，这些发现对临床医生具有重要的临床意义，值得在当前表格的潜在修订中考虑。在未来研究的设计中，必须认识到发生许多开关的临床环境的复杂性，并认识到这一点。(C)美国癌症疼痛缓解委员会，2001年。
Clinicians involved in the opioid pharmacotherapy of cancer-related pain should be acquainted with a variety of opioids and be skilled in the selection of doses when the type, (of opioid or route of administration needs changing. The optimal dose should avoid underdosing or overdosing, both associated with negative outcomes for the patient. Although equianalgesic dose tables are generally used to determine the new doses in these circumstances, the evidence to support the ratios indicated in these tables largely refers to the context of single dose administration. The applicability of these ratios to the setting of chronic opioid administration has been questioned. A systematic search of published literature from 1966 to September 1999 was conducted to critically appraise the emerging evidence on equianalgesic dose ratios derived from studies of chronic opioid administration. There were six major findings: 1) there exists a general paucity of data related to long-term dosing and studies are heterogeneous in nature; 2) the ratios exhibit extremely wide ranges; 3) methadone is more potent than previously appreciated; 4) the ratios related to methadone are highly correlated with the dose of the previous opioid; 5) the ratio may change according to the direction the opioid switch; and 6) discrepancies exist with respect to both oxycodone and fentanyl. Overall, these findings have important clinical implications for clinicians and warrant consideration in the potential revision of current tables. The complexity of the clinical context in which many switches occur must be recognized and also appreciated in the design of future studies. (C) U.S. Cancer Pain Relief Committee, 2001.