Dose Conversion in Opioid Rotation from Continuous Intravenous Infusion of Morphine Hydrochloride Injection to Fentanyl Patch in the Management of Cancer Pain

OBJECTIVE: To report a case of high transdermal fentanyl dosage requirements in a patient with chronic cancer pain. DATA SOURCES: Clinical studies, review articles, and relevant laboratory information. CASE SUMMARY: A 42-year-old woman with cervical cancer was admitted for control of her pain. Her outpatient analgesic regimen was a continuous intravenous infusion of morphine sulfate (MS) via an ambulatory infusion device. Upon admission, supplemental doses of intravenous MS were administered in an effort to eliminate the pain. Transdermal fentanyl therapy was initiated on hospital day 1 at 100 μg/h and the MS continuous intravenous infusion dosage was increased. Over the next four days, the patient experienced episodes of inadequate pain control and the transdermal fentanyl dosage was increased in increments of 100 μg/h. On hospital day 4 the MS continuous infusion was converted to patient-controlled analgesia (PCA). The patient reported acceptable pain control with a regimen of transdermal fentanyl 500 μg/h and MS via PCA and she was discharged home on hospital day 7. CONCLUSIONS: This patient's high transdermal fentanyl dosage requirement was related to disease progression. She experienced an acute pain episode that may have been effectively managed by increasing the dosage of her continuous intravenous MS infusion.

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Treatment of cancer pain of the head and neck by continuous intravenous infusion of high-dose morphine: Report of two cases

Journal of Oral and Maxillofacial Surgery ◽

10.1016/0278-2391(90)90439-9 ◽

1990 ◽

Vol 48 (4) ◽

pp. 398-400 ◽

Cited By ~ 6

Author(s):

Yutaka Hashimoto ◽

Manabu Takarada ◽

Hiroaki Tanioka ◽

Benjamin M. Rigor

Keyword(s):

Cancer Pain ◽

Head And Neck ◽

Intravenous Infusion ◽

High Dose ◽

Continuous Intravenous Infusion

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Efficacy of octreotide (Octrade) for prevention of pancreatitis after endoscopic retrograde cholangiopancreatography

Medical alphabet ◽

10.33667/2078-5631-2020-30-30-36 ◽

2020 ◽

Vol 1 (30) ◽

pp. 30-36

Author(s):

E. A. Krylova ◽

D. V. Aleinik

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Intravenous Infusion ◽

Pancreatic Enzyme ◽

Enzyme Secretion ◽

Continuous Intravenous Infusion ◽

Endoscopic Retrograde ◽

Pancreatic Enzyme Secretion

The article presents the results of a study of the effectiveness of the use of an inhibitor of pancreatic enzyme secretion of octreotide (Octrade) for the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). It was shown that the administration of Octrade at a dose of 0.3 mg in 500 ml of 0.9 % NaCl by continuous intravenous infusion for 7 hours and then 0.1 mg of Octrade subcutaneously at 6 and 12 hours after the end of intravenous infusion significantly reduced the frequency of pancreatitis (4.0 % and 22.2 %; p < 0.05) and hyperamylasemia (8.0 % and 25.9 %; p < 0.05) after ERCP. It is concluded that Octrade is effective in preventing the development of pancreatitis and hyperamilasemia after ERCP.

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Faculty Opinions recommendation of Influence of serum albumin levels during opioid rotation from morphine or oxycodone to fentanyl for cancer pain.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725326091.793503428 ◽

2015 ◽

Author(s):

Mellar Davis

Keyword(s):

Serum Albumin ◽

Cancer Pain ◽

Opioid Rotation

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Short-course IL-15 given as a continuous infusion led to a massive expansion of effective NK cells: implications for combination therapy with antitumor antibodies

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002193 ◽

2021 ◽

Vol 9 (4) ◽

pp. e002193

Author(s):

Sigrid P Dubois ◽

Milos D Miljkovic ◽

Thomas A Fleisher ◽

Stefania Pittaluga ◽

Jennifer Hsu-Albert ◽

...

Keyword(s):

Nk Cells ◽

Natural Killer ◽

Intravenous Infusion ◽

Nk Cell ◽

Continuous Intravenous Infusion ◽

Dose Escalation Study ◽

Link Type ◽

Best Response ◽

Antitumor Antibodies ◽

Interleukin 15

BackgroundFull application of cytokines as oncoimmunotherapeutics requires identification of optimal regimens. Our initial effort with intravenous bolus recombinant human interleukin-15 (rhIL-15) was limited by postinfusional reactions. Subcutaneous injection and continuous intravenous infusion for 10 days (CIV-10) provided rhIL-15 with less toxicity with CIV-10 giving the best increases in CD8+ lymphocytes and natural killer (NK) cells. To ease rhIL-15 administration, we shortened time of infusion. Treatment with rhIL-15 at a dose of 3–5 µg/kg as a 5-day continuous intravenous infusion (CIV-5) had no dose-limiting toxicities while effector cell stimulation was comparable to the CIV-10 regimen.MethodsEleven patients with metastatic cancers were treated with rhIL-15 CIV-5, 3 µg (n=4), 4 µg (n=3), and 5 µg/kg/day (n=4) in a phase I dose-escalation study (April 6, 2012).ResultsImpressive expansions of NK cells were seen at all dose levels (mean 34-fold), including CD56bright NK cells (mean 144-fold for 4 µg/kg), as well as an increase in CD8+ T cells (mean 3.38-fold). At 5 µg/kg/day, there were no dose-limiting toxicities but pulmonary capillary leak and slower patient recovery. This led to our choice of the 4 µg/kg as CIV-5 dose for further testing. Cytolytic capacity of CD56bright and CD56dim NK cells was increased by interleukin-15 assayed by antibody-dependent cellular cytotoxicity (ADCC), natural cytotoxicity and natural killer group 2D-mediated cytotoxicity. The best response was stable disease.ConclusionsIL-15 administered as CIV-5 substantially expanded NK cells with increased cytotoxic functions. Tumor-targeting monoclonal antibodies dependent on ADCC as their mechanism of action including alemtuzumab, obinutuzumab, avelumab, and mogamulizumab could benefit from those NK cell expansions and provide a promising therapeutic strategy.Trial registration numbersNCT01572493, NCT03759184, NCT03905135, NCT04185220 and NCT02689453.

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Phase I to II Multicenter Study of Oblimersen Sodium, a Bcl-2 Antisense Oligonucleotide, in Patients With Advanced Chronic Lymphocytic Leukemia

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.4364 ◽

2005 ◽

Vol 23 (30) ◽

pp. 7697-7702 ◽

Cited By ~ 142

Author(s):

Susan M. O'Brien ◽

Charles C. Cunningham ◽

Anatoliy K. Golenkov ◽

Anna G. Turkina ◽

Steven C. Novick ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Phase I ◽

Phase Ii ◽

Intravenous Infusion ◽

Single Agent ◽

Plasma Concentrations ◽

Parent Drug ◽

Lymphocytic Leukemia ◽

Complete Disappearance ◽

Continuous Intravenous Infusion

Purpose To determine the maximum-tolerated dose (MTD), efficacy, safety, and pharmacokinetics of oblimersen sodium in patients with advanced chronic lymphocytic leukemia (CLL). Patients and Methods Eligible patients had relapsed or refractory CLL after treatment with fludarabine. Oblimersen was administered at doses ranging from 3 to 7 mg/kg/d as a 5-day continuous intravenous infusion in cycle 1 and as a 7-day continuous intravenous infusion in subsequent cycles every 3 weeks in stable or responding patients. Results Forty patients were enrolled and treated (14 patients in phase I and 26 patients in phase II). Dose-limiting reactions in phase I included hypotension and fever, and the MTD for phase II dosing was established at 3 mg/kg/d. Two (8%) of 26 assessable patients achieved a partial response. Other evidence of antitumor activity included ≥ 50% reduction in splenomegaly (seven of 17 patients; 41%), complete disappearance of hepatomegaly (two of seven patients; 29%), ≥ 50% reduction of lymphadenopathy (seven of 22 patients; 32%), and ≥ 50% reduction in circulating lymphocyte counts (11 of 22 patients; 50%). Adverse events included transient hypotension, fever, fatigue, night sweats, diarrhea, nausea, vomiting, hypokalemia, and cough. Plasma concentrations of oblimersen (parent drug) and its major metabolites were variable. Renal clearance represented only a small portion of total parent drug clearance. Conclusion Dosing with oblimersen sodium in patients with CLL is limited by development of a cytokine release syndrome that is characterized by fever, hypotension, and back pain. Oblimersen sodium has modest single-agent activity in heavily pretreated patients with advanced CLL, and further evaluation of its activity in combination with cytotoxic drugs is warranted.

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