Pharmaceutical pitfalls in treating patients with advanced cancer.

BACKGROUND

This paper presents a collection of important topics that are not related to the other Focus papers in this AJGP issue on palliative care but are nevertheless important for clinical practice.

OBJECTIVE

This article reviews the safe use of fentanyl, the proper use of buprenorphine and oxycodone-naloxone, and the potential pitfalls of equianalgesic tables.

DISCUSSION: Sublingual and transdermal fentanyl are contraindicated in patients who are opioid-naïve. Opioid-naïve has a strict definition. Buprenorphine does not reduce the efficacy of other analgesics. Equianalgesic tables should not be followed blindly - they have many shortcomings, even if they are the best guidance we have. The benefit of combined oxycodone-naloxone products is modest in patients receiving palliative care in whom there is a higher risk of therapeutic failure and adverse effects. In summary, these are clinical topics that frequently arise when specialist input is sought but are not directly addressed in most clinical articles.