The role of methadone in opioid rotation—a Polish experience
- 215 Downloads
To assess methadone analgesia, adverse effects, and calculation method of equianalgesic doses with oral morphine.
Materials and methods
Methadone was administered to 21 opioid-tolerant cancer patients because of pain (numerical rating scale [NRS] > 5) on morphine (ten patients), transdermal fentanyl (TF; four patients), morphine, ketamine, and TF (one patient), tramadol (one patient), pethidine (one patient), pain with drowsiness on morphine with ketamine (three patients), and pain with nausea on morphine (one patient). Dose ratios of equivalent daily dose of oral morphine (ddom) to daily dose of oral methadone (ddomet) were 4:1 (ddom to 100 mg), 6:1 (101–300 mg), 12:1 (301–1,000 mg), and 20:1 (over 1,000 mg). Previous opioid treatment was stopped completely (stop–start approach) in 19 patients; two received methadone and other opioids. The mean ddom before switch was 812 ± 486 mg. Methadone was administered regularly three times daily; 20 patients received oral methadone, one patient received rectal suppositories. Breakthrough pain was treated with methadone (half of regular dose), morphine, fentanyl, metamizol, ketoprofen, or ketamine.
Mean time of methadone treatment was 38.3 ± 27.1 days (range 3–95 days), mean daily doses: start 48.1 ± 19.7 mg, maximal 148.5 ± 104.1 mg, treatment completion 131.1 ± 104.3 mg. Good analgesia (NRS < 4) was observed in 11 patients, partial (NRS 4–5) in nine patients, and unsatisfactory (NRS > 5) in one patient. Adverse effects such as drowsiness (six patients), constipation (six patients), nausea and vomiting (two patients), sweating (two patients), and respiratory depression (one patient) the last one resolved by methadone cessation and naloxone.
Results confirmed high analgesic efficacy, acceptable methadone adverse event profile, safety, and effectiveness of ddom to ddomet dose calculation method.
KeywordsCancer pain Methadone Opioid analgesics Opioid rotation Opioid switch
- 4.Bruera E, Pereira J, Watanabe S, Belzile M, Kuehn N, Hanson J (1996) Opioid rotation in patients with cancer pain. A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine. Cancer 78:852–857 doi:10.1002/(SICI)1097-0142(19960815)78:4<852::AID-CNCR23>3.0.CO;2-TPubMedCrossRefGoogle Scholar
- 5.Cherny N, Ripamonti C, Pereira J, Davis C, Fallon M, McQuay H, Mercadante S, Pasternak G, Ventafridda V, Expert Working Group of the European Association of Palliative Care Network (2001) Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 19(9):2542–2554PubMedGoogle Scholar
- 15.Gannon G (1997) The use of methadone in the care of dying. Eur J Palliat Care 4(5):152–158Google Scholar
- 18.Hanks GW, de Conno F, Cherny N, Hanna M, Kalso E, McQuay HJ, Mercadante S, Meynadier J, Poulain P, Ripamonti C, Radbruch L, Roca i Casas J, Säwe J, Twycross RG, Ventafridda V, Expert Working Group of the Research Network of the European Association for Palliative Care (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84(5):587–593PubMedCrossRefGoogle Scholar
- 20.Lawlor PG, Turner KS, Hanson J, Bruera ED (1998) Dose ratio between morphine and methadone in patients with cancer pain. A retrospective study. Cancer 82(6):1167–1183 doi: 10.1002/(SICI)1097-0142(19980315)82:6<1167::AID-CNCR23>3.0.CO;2-3 PubMedCrossRefGoogle Scholar
- 25.Mercadante S (1999) Opioid rotation for cancer pain. Rationale and clinical aspects. Cancer 86:1856–1866 doi: 10.1002/(SICI)1097-0142(19991101)86:9<1856::AID-CNCR30>3.0.CO;2-G PubMedCrossRefGoogle Scholar
- 40.Simmonds MA, Payne R, Richenbacher J, Moran K, Southam NA, Hershey MS (1989) TTS (fentanyl) in the management of pain in patients with cancer. Proc Am Soc Clin Oncol 8:324Google Scholar
- 42.Twycross R, Back I (1998) Nausea and vomiting in advanced cancer. Eur J Palliat Care 5(2):39–45Google Scholar