From the Research
When converting a patient from hydromorphone to Butrans due to gastrointestinal side effects, the initial recommended dose depends on the patient's current daily hydromorphone dose, and for patients taking 2 mg hydromorphone q 6 hours (approximately 8 mg daily), start with Butrans 10 mcg/hour patch, as this dose is likely to provide equivalent analgesia while minimizing side effects, as supported by studies such as 1.
The patient in question is taking 2 mg hydromorphone every 6 hours, which translates to approximately 8 mg per day. Given this dosage, the most appropriate initial dose of Butrans would be 10 mcg/hour, as it is likely to provide comparable analgesic effects while potentially reducing gastrointestinal side effects.
- Key considerations when transitioning from hydromorphone to Butrans include:
- Tapering the hydromorphone dose to avoid withdrawal symptoms
- Initiating Butrans at the next scheduled hydromorphone dose
- Providing breakthrough pain medication as needed during the transition period
- Monitoring the patient closely for signs of withdrawal or inadequate pain control
The Butrans patch should be applied to intact skin and changed every 7 days, as indicated by the manufacturer's instructions and supported by pharmacokinetic studies such as 2.
It's also important to note that Butrans may cause less constipation and nausea compared to full opioid agonists like hydromorphone due to its partial agonist properties and ceiling effect on mu-opioid receptors, making it a beneficial option for patients experiencing gastrointestinal side effects from traditional opioids, as discussed in studies like 1 and 3.
Overall, the goal of converting the patient to Butrans is to maintain adequate analgesia while improving their quality of life by reducing gastrointestinal side effects, and the chosen dose should be based on the patient's current opioid regimen and individual needs, with careful monitoring and adjustments as necessary.