What is the FDA definition of opioid tolerance in palliative cancer care?

Updated: Aug 13, 2018
  • Author: Winston W Tan, MD, FACP; more...
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Answer

Answer

For pain related to an oncologic emergency, such as bone fracture, infection, or obstruction, the NCCN recommends treating the pain directly in addition to providing specific treatment for the underlying condition (eg, surgery, steroids, radiation therapy, antibiotics). For pain not related to an oncologic emergency, NCCN recommendations vary according to whether the patient is opioid naïve or opioid tolerant. The U.S. Food and Drug Administration (FDA) defines opioid tolerance as receiving, for 1 week or longer, one of the following [9] :

  • 60 mg oral morphine/day
  • 25 mcg transdermal fentanyl/hour
  • 30 mg oral oxycodone/day
  • 8 mg oral hydromorphone/day
  • 25 mg oral oxymorphone/day
  • An equianalgesic dose of another opioid

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