Transdermal buprenorphine is a new formulation of the old drug available for the treatment of cancer and non-cancer pain. The drug offers number of interesting new features and was found effective in clinical trials in cancer patients with pain. We performed a survey of the use of buprenorphine patches for one year. In the survey we included 58 admitted patients (67 admission periods), whose clinical records and drug charts were subjected to analysis. Opioid naive patients were started either on 5 or 10 μg/hour. Mean buprenorphine dose was 22.3 μg/hour (95% CI: 16–28.6), increased on day 8 to 25.4 μg/hour (95% CI: 18.6–32) and ended up at the dose of 31.3 μg/hour (95% CI: 20.9–41.6) on the last day of treatment; day 19 (95% CI: 14.5–23.5). The overall dose increase was approximately 2% per day. Approximately half of the patients needed beside buprenorphine other opioids either in a slow release or immediate release form, usually morphine or oxycodone. Swapping from morphine, oxycodone and fentanyl to buprenorphine was without problems in all of the cases. The doses of all opioids administered calculated as oral morphine equivalents showed insignificant decreases for morphine and oxycodone to buprenorphine swaps. In case of fentanyl the oral morphine equivalents of opioids were significantly lower after swap (p = 0.0039). No signs of antagonism between the drugs were observed. In conclusion: buprenorphine patches appear to be useful in the treatment of cancer pain, either as monotherapy or in combination with other opioids. Swap from fentanyl to buprenorphine offers perspective of achievement of pain control with much less toxicity and should be investigated in more detail.
Adv. Pall. Med. 2010; 9, 2: 39–44