Respuesta :

Some advantages are:
-improving analgesia (eg, rotating to methadone patients with neuropathic pain)
-reducing side effects (eg, rotating to hydromorphone for pruritus)
-practical concerns (eg, use of large number of pills of immediate release hydromorphone can be cumbersome; rotation can over come this problem)
-cost reduction (eg, rotating to methadone or morphine)
-better compliance (eg, rotating to transdermal fentanyl if the person is unable to comply with oral regimen)
-use in organ failure (eg, rotating to methadone or fentanyl in kidney failure, or rotating to morphine in severe liver failure when side effects occur)

Some disadvantages are:
-inaccuracy of conversion tables (eg, conversion to methadone is based on prior opioid dose and is not fit into the ratio)
-limited access (eg, rotating to oral hydromorphone obligates patients to take it every four hours, including awakening at night)
-drug interactions (eg, addition of fluconazole to methadone can elicit opioid toxicity)
-expense (eg, rotating to sustained release oxycodone in an uninsured person)
-varies availability of opioids in pharmacy’s (eg,minority neighborhood pharmacies)
-difficulty in rotating from methadone
-attracting regulatory attention (eg, frequent rotations or rotating to large doses of oxycodone)

hope this helped!

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