The median opioid rotation ratio (ORR) from the oral morphine equivalent daily dose (MEDD) to transdermal fentanyl in milligrams per day was 0.01, a new study published online ahead of print in the journal Cancer has shown.

Although transdermal fentanyl is one of the most common opioids prescribed to patients with cancer, the accurate ORR from other opioids to transdermal fentanyl is not clear.

Therefore, researchers at The University of Texas MD Anderson Cancer Center in Houston, TX, sought to the determine the ORR of the MEDD to the transdermal fentanyl dose when correcting for the MEDD of breakthrough opioid in patients with cancer receiving outpatient care.

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For the study, researchers analyzed the records of 6,790 patients who received supportive care at MD Anderson Cancer Center from 2010 to 2013. Of those, 129 underwent opioid rotation from other opioids to transdermal fentanyl.

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Results showed that uncontrolled pain was the most frequent reason for opioid rotation, which was experienced by 80% of patients.

Researchers found that in 101 patients who underwent opioid rotation and had no worsening pain at follow-up, the median ORR from the net MEDD to transdermal fentanyl was 0.01, meaning that a total oral morphine equivalent dose of 100 mg per day is equivalent to 1 mg of transdermal fentany daily or about 40 μg per hour of fentanyl (1,000 μg/24 hours).

The authors noted that these results warrant further studies to confirm their findings.


  1. Reddy A, Tayjasanant S, Haider A, et al. The opioid rotation ratio of strong opioids to transdermal fentanyl in cancer patients [published online ahead of print October 9, 2015]. Cancer. doi: 10.1002/cncr.29688.