skip to main content

Opioid Rotation — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateSupportive & Palliative OncologyOpioid RotationSCE Medical Oncology

A 55-year-old woman on palliative morphine sulfate modified-release 60 mg BD for cancer pain reports adequate pain control but intolerable nausea. She has tried dose reduction without adequate analgesia. What is the most appropriate management strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Switch to a fentanyl patch (opioid rotation) using equianalgesic dose tables

When a patient has intolerable adverse effects from one opioid despite adequate analgesia, opioid rotation (switching to an alternative opioid) is the recommended strategy. Due to incomplete cross-tolerance, the equianalgesic dose of the new opioid is typically reduced by 25-50%. Morphine 120 mg/day oral = approximately fentanyl 50 mcg/hour patch. Opioid rotation exploits inter-individual variation in opioid receptor pharmacology. Common alternatives include fentanyl, oxycodone, and hydromorphone.

Reference: NICE CG140 Opioids in palliative care; ESMO 2024 Pain Management Guidelines; Palliative Care Formulary