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Practicability, safety, and efficacy of a “German model” for opioid conversion to oral levo-methadone

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Abstract

Introduction

An algorithm to convert from any other opioid to oral levo-methadone was developed in Germany, the German model of levo-methadone conversion (GMLC). According to this GMLC, the pre-existing opioid is stopped, then titration of oral levo-methadone is initiated with a starting dose of 5 mg orally q 4 h (plus prn q 1 h). If necessary, levo-methadone dose is increased (pain) or decreased (side effects) by 30% q 4 h (plus prn q 1 h). After 72 h, the achieved single dose is maintained, but the dosing interval increases twofold to q 8 h (plus prn q 3 h). The aim of this study was to obtain information about the practicability, safety, and efficacy of the GMLC in clinical routine.

Methods

A retrospective, systematic chart review of levo-methadone conversions for the treatment of pain in inpatient palliative care was performed.

Results

Fifty-two patients were analyzed. The dosing interval was increased correctly after 72 h as demanded by the GMLC in 60% of patients. In 85% of the patients, opioid medication with levo-methadone could be maintained until the end of the inpatient stay. In three patients (6%), levo-methadone administration had to be stopped due to side effects. No serious adverse events could be detected during opioid rotation. Pain intensity was reduced significantly (p < 0.001) after conversion concerning mean (NRS 0.9; range 0–4) and maximum pain over the day (NRS 3.9; range 0–10).

Conclusion

The presented study indicates that the GMLC provides a practical and reasonably safe approach to perform opioid rotation to levo-methadone in a palliative care setting.

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Acknowledgement

The scientific work of the Division of Palliative Medicine, Erlangen, and the departments of Palliative Medicine in Cologne and Goettingen are substantially supported by the German Cancer Aid (Deutsche Krebshilfe e.V.). The scientific work of the Department of Palliative Medicine, University Clinic of Cologne is supported by the Federal Ministry for Education and Science (BMBF 01KN0706).

Conflict of interest

Christoph Ostgathe receives remuneration from Mundipharma, Nycomed, Grünenthal and Cephalon and funding from Mundipharma. Raymond Voltz receives remuneration from Mundipharma, Cephalon and Lilly and funding from Mundipharma and Cephalon. Rainer Sabatowski receives remuneration from Grünenthal, Nycomed, MSD and Janssen-Cilag and is advisor for Cephalon. Friedemann Nauck receives remuneration from Mundipharma, Cephalon, Archimedes, Nycomed and Sanovi Aventis and funding from Sanofi Aventis. Jan Gärtner receives remuneration from Mundipharma, Cephalon, Pfizer and Archimedes and funding from Mundipharma and Cephalon. The authors declare to have no conflicts of interest regarding this study and that they have full control of all primary data. They agree to allow the journal to review their data if requested.

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Authors and Affiliations

  1. Division of Palliative Medicine, University of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany

    Christoph Ostgathe & Carsten Klein

  2. Centre for Palliative Medicine, University of Cologne, Cologne, Germany

    Raymond Voltz, Annika Van Aaaken & Jan Gaertner

  3. Department of Anaesthesiology, University Hospital “Carl Gustav Carus”, Dresden, Germany

    Rainer Sabatowski

  4. Department of Palliative Medicine, University of Goettingen, Goettingen, Germany

    Friedemann Nauck

  5. Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany

    Raymond Voltz & Jan Gaertner

  6. Clinical Trials Center Cologne, BMBF 01KN0706, Cologne, Germany

    Friedemann Nauck & Jan Gaertner

  7. Comprehensive Pain Center, University Hospital “Carl Gustav Carus”, Dresden, Germany

    Rainer Sabatowski

Authors
  1. Christoph Ostgathe
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  2. Raymond Voltz
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  3. Annika Van Aaaken
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  4. Carsten Klein
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  5. Rainer Sabatowski
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  6. Friedemann Nauck
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  7. Jan Gaertner
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Corresponding author

Correspondence to Christoph Ostgathe.

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Ostgathe, C., Voltz, R., Van Aaaken, A. et al. Practicability, safety, and efficacy of a “German model” for opioid conversion to oral levo-methadone. Support Care Cancer 20, 2105–2110 (2012). https://doi.org/10.1007/s00520-011-1320-8

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  • DOI: https://doi.org/10.1007/s00520-011-1320-8

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