Which opioid is often preferred for patients unable to tolerate morphine or hydromorphone due to its potency?

Fentanyl is often preferred for patients who cannot tolerate morphine or hydromorphone because of its high potency and rapid onset of action. As a synthetic opioid, fentanyl is considerably more potent than morphine, offering effective pain relief at lower doses, which can be particularly beneficial for patients who experience side effects from other opioids. Its delivery forms, such as transdermal patches or lozenges, allow for flexibility in administration, making it easier for some patients to manage their pain without the adverse effects associated with longer-acting opioids.

While hydromorphone is another potent opioid, it is still related to morphine and may not significantly reduce the side effects that some patients experience with morphine. Methadone, while also being a strong opioid, is primarily used for chronic pain or opioid dependence and has a complex pharmacology that requires careful monitoring. Meperidine is typically not preferred due to its potential for side effects, including seizures, especially with prolonged use or accumulation in the body. Thus, fentanyl stands out as the optimal choice for patients with intolerance to morphine or hydromorphone due to its effectiveness and favorable profile when used appropriately.