1793P - Painkiller-related dizziness in malignant tumors: A systematic review

Abstract

Background: To our knowledge, there is no systematic review on painkiller-related dizziness, which often occurs. Methods: Papers from core clinical journals on PubMed-database resulted in 340 articles on dizziness in malignant tumors until 31st Dec 2017. Eight studies with level of evidence (LoE) 1 focused on dizziness as a side effect of painkillers. Results: In a meta-analysis on codeine, dizziness was reported in 18.06 % of patients (LoE 1a) [1]. In randomized controlled trials (LoE 1b), oxycodone-associated dizziness was only seen in controlled release (8.3 %) and not in immediate release oxycodone [2]. In a systematic review (LoE 1a) [3], controlled release oxycodone was associated with 11.9 % of dizziness reports. A meta-analysis on immediate release morphine and transmucosal fentanyl (7 % dizziness) favoured transmucosal fentanyl for breakthrough cancer pain, but did not differentiate between the painkillers for dizziness [4]. Effective analgesia with rare (1.8 to 7.5 %) events of dizziness was reported for intranasal fentanyl spray (LoE 1b) [5]. For long-acting analgesia, a systematic review favoured transdermal fentanyl over sustained release oral morphine (LoE 1a) [6]. A randomized controlled trial in bone metastases favoured the combination of two nonsteroidal anti-inflammatory drugs (NSAIDs) plus morphine (10.3 % dizziness reports) over one NSAID plus morphine (> 25 %), presumably due to lower morphine need in two NSAIDs (LoE 1b) [7]. Finally, both hydromorphone and morphine had at least 15 % of dizziness reports in a systematic review (LoE 1a) [8]. Conclusions: There is level of evidence 1a to 1b that immediate release oxycodone, transmucosal or intranasal fentanyl are associated with the lowest incidence of dizziness. For long-acting analgesia, transdermal fentanyl is a promising option.