Challenging the equipotency calculation for transdermal buprenorphine: four case studies


  • Disclosure
    The authors have no financial or other relationships that might lead to a conflict of interest. The authors agree to the copyright transfer and submission of this article for consideration for publication in the International Journal of Clinical Practice.

Dr Rudolf Likar, MD,
Interdisciplinary Pain Clinic, General Hospital Klagenfurt, St. Veither Strasse 47, 9026 Klagenfurt, Austria
Tel.: + 43 463 538-26120
Fax: + 43 463 538-23704


Aims:  Opioids produce analgesia via different pain pathways. The aim of these case studies was to address the issue of opioid rotation or switching, raising the important issue of conversion ratios between different compounds and routes of administration.

Results:  We present two cases of neuropathic pain and two cases of nociceptive pain with a significant neuropathic component, which were successfully treated with transdermal buprenorphine after the failure of other opioids.

Conclusion:  In each case, effective pain relief was produced by a lower dose than the proposed equipotency ratio of 1 : 75 would indicate, suggesting that a ratio of 1 : 110 to 1 : 115 may be more appropriate.