title: Opioid hyperexcitability: the application of alternate opioid therapy.
abstract: Three cases are reported where patients experienced severe central nervous system adverse effects on high-dose hydromorphone. These effects were rapidly alleviated following a change in therapy to morphine at 20-25% of the usually accepted potency equivalent dose. We recommend caution in using equivalent dose tables when changing opioid therapy in patients receiving high-dose opioid treatment.
authors.affiliation: Alberta Cancer Foundation, University of Alberta, Edmonton, Alb. T6G 2J3 Canada British Columbia Cancer Agency, Victoria, BC V8R IJ8 Canada Queen Elizabeth Hospital, Charlottetown, PEI CIA 8T5 Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: MacDonald
authors.forename: Linda
authors.initials: L
authors.lastname: Der
authors.forename: Sharon
authors.initials: S
authors.lastname: Allan
authors.forename: Phillip
authors.initials: P
authors.lastname: Champion
mesh_terms: D000328:Adult; D000368:Aged; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009207:Myoclonus / Q000139:chemically induced; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology
chemical_list: D009294:Narcotics; D009020:Morphine; D004091:Hydromorphone