How should opioids be titrated in the elderly?
Due to the extensive side effects associated with opioids, patients should be monitored closely and frequently for efficacy and side effects. Opioids should be started low and titrated slowly, taking into account kidney and liver function.
When starting an opioid, it is recommended to start an immediate release opioid at the lowest effective dose with slow titration as needed. As a generalization, starting at a dose 25% to 50% less than the dose that would be given to a younger patient is recommended. When titrating opioids, practice guidelines suggest increasing dosages by 25% to 50% in those with mild to moderate pain and by 50% to 100% in those with moderate to severe pain. Once effective analgesia is obtained, the immediate release opioid dose may be converted to extended release formulations, if appropriate.
In the case of opioid rotation and converting from one opioid to another, the new opioid should be initiated at 50% to 67% of the current total opioid dose.