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Opioid Neurotoxicity — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyOpioid NeurotoxicitySCE Medical Oncology

A 62-year-old man with cancer on opioids develops myoclonic jerks on morphine 200mg BD. What is the cause and management?

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Correct answer: BOpioid neurotoxicity from M3G/M6G metabolite accumulation — management is opioid ROTATION (not dose increase) to agents with fewer active metabolites (fentanyl, oxycodone)

Opioid neurotoxicity: myoclonus, allodynia, hallucinations from M3G accumulation. Risk factors: high dose, renal impairment. Rotate to fentanyl (no active metabolites) or oxycodone. Hydration also helps.

Reference: NICE CG140; Palliative Care Formulary