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Methadone and Buprenorphine Prescribing in the Palliative Care Population

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Handbook of Methadone Prescribing and Buprenorphine Therapy

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Abstract

Opioids are the mainstay of pain management in terminally ill patients. Methadone and buprenorphine are two potent mu-opioid receptor agonists predominantly used in the medical treatment of opioid addiction. In the past two decades there is emerging evidence for their efficacy and potential advantages of these agents over other agents in certain clinical situations such as refractory pain and neuropathic pain syndromes, and in the presence of renal failure, which are frequently encountered in the palliative care setting. However, methadone and buprenorphine have unique and complex pharmacological characteristics including a prolonged half-life, and metabolism by cytochrome P450 enzymes that need to be understood for safe administration of these drugs. Further, the optimal equianalgesic conversion ratios with morphine has not been clearly determined, and necessitates a cautious approach when opioid rotation is undertaken. Due to these issues, these agents should be prescribed by clinicians with relevant knowledge and experience.

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Acknowledgment

Eduardo Bruera is supported in part by National Institutes of Health grant numbers: RO1NR010162-01A1, RO1CA122292-01, RO1CA124481-01.

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  1. Department of Palliative Care and Rehabilitation Medicine—Unit 1414, The University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA

    Shalini Dalal MD & Eduardo Bruera MD

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  1. Shalini Dalal MD
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  2. Eduardo Bruera MD
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Correspondence to Shalini Dalal MD .

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  1. , Dept of Pain Med and Palliative Care, Beth Israel Medical Center, Union Square East 10, New York, 10003, New York, USA

    Ricardo A. Cruciani

  2. , Dept of Pain Mgmt and Palliative Care, Beth Israel Medical Center, East 17th Street 350, New York, 10003, New York, USA

    Helena Knotkova

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Dalal, S., Bruera, E. (2013). Methadone and Buprenorphine Prescribing in the Palliative Care Population. In: Cruciani, R., Knotkova, H. (eds) Handbook of Methadone Prescribing and Buprenorphine Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6974-2_17

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