Alternatives to oral opioids for cancer pain

Although the optimal route of administration of opioids is hy mouth, some p atients may require alternative routes during the course of their illnesses for sever al reasons. These include bowel obstruction, severe emesis, or s evere dysphagia. In these cases, the alternatives include the subcutaneous or rectal route, The transdermal route also provides a simple, comfortable method that produces stable blood drug concentrations. The high potency and lipid solubility of fentanyl make it suitable for this route of administra tion. Iontophoresis can provide a rapid drug delivery rate, but no clinical studies exist to document the long-term effectiveness of this method in co ntrolling pain. The transmucosal route is recommended only for those opioid s with high solubility, such as buprenorphine, the fentanyl series, and met hadone. Oral transmucosal fentanyl (Actiq) provides a rapid onset of pain r elief and is appropriate for treating episodes of breakthrough pain.