Is there a rationale for concurrently prescribing multiple long-acting opioid analgesics?

Presently, evidence does not support the concurrent and continued use of more than one long-acting opioid analgesic. And, depending on the half-lives and dosing intervals of multiple long-acting opoids, there is a potential for harmful drug accumulation and additive adverse effects over time. In certain cases, a patient might receive two long-acting opioids concurrently for a brief time when the intent is to wean the patient off one agent and onto the other.

The dose of one is appropriately tapered while the other agent is titrated upward. In clinical practice, it is more common to use a long-acting analgesic dosed appropriately to control baseline chronic pain, and to add a short-acting analgesic as a rescue medication taken for episodes of breakthrough pain. Guideline recommendations include the following points: • Rational polypharmacy could include the use of two or more drugs with complementary mechanisms of action, and this may provide greater pain relief at lower doses of each ... more.

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