Clinical experience with oral methadone administration in the treatment of pain in 196 advanced cancer patients.

Abstract

Oral methadone administered every 8 hours was shown to be an appropriate analgesic therapy in the treatment of advanced cancer-related pain. The worsening of the other symptoms under study can be considered linked to the progression of the disease, and in fact, only a small percentage of the patients reported methadone-related side effects that warranted suspension of treatment. We consider oral methadone to be a useful analgesic therapy, and it should be considered in clinical practice for the treatment of cancer pain.

Análise clínica e terapêutica dos pacientes oncológicos atendidos no programa de dor e cuidados paliativos do Hospital Universitário Clementino Fraga Filho no ano de 2003

“…Não tem metabólitos ativos, possuindo impregnação em outros tecidos (em média cinco dias). Pode ser utilizada com maior intervalo entre doses [17][18][19][20] . A dose da metadona na primeira semana é individualizada, com grande variabilidade entre os pacientes e a sua interação com outros fármacos (rifampicina, fenitoína, espirolactona, álcool, Vol.…”

“…It does not have active metabolites and impregnates other tissues (a mean of five days). It can be prescribed with a longer interval between doses [17][18][19][20] . The dose of methadone was individualized in the first week, with a great variability among patients, and its interaction with other drugs (riphampin, fenitoin, spironolactone, alcohol, verapamil, estrogens) decreased its plasma concentration, which are the major obstacles to its use [21][22][23] .…”

“…This is important because this protein is elevated in cancer patients and in patients treated with amitriptyline, decreasing the free fraction of this medication, leading to an increase in its dose, and decreasing the interval, until a balance between tissues and plasma is achieved. Urine pH is very important in reducing the clearance of methadone, i.e., the lower the urine pH the lower the blood concentration of methadone [19][20][21][22] . In this study, after PCA with methadone in the first week patients did not present side effects, such as sedation, nausea and vomiting, myoclonus, respiratory depression, and hallucination.…”

“…Esse fato é relevante, porque nos pacientes oncoló-gicos e naqueles em uso de amitriptilina, essa proteína está elevada no sangue, diminuindo as frações livres desse medicamento e fazendo com que esses pacientes precisem de doses maiores de metadona em intervalos menores de tempo, até que se alcance o equilíbrio entre os tecidos e o plasma. O pH urinário é determinante na diminuição da depuração da metadona, isto é, quanto menor o pH urinário menor a concentração da metadona no sangue [19][20][21][22] . Neste estudo, após a PCA com a metadona, os pacientes não apresentaram efeitos colaterais na primeira semana como sedação, náuseas e vômitos, mioclonias, depressão respiratória e alucinação.…”

The Use of Methadone in Refractory Headache Pain in an Opiate Naive Patient with Non Metastatic Burkitt’s Lymphoma and HIV - A Case Report

“…It is important to recognize the favoring of long lasting opiates over shorter acting in a patient with chronic pain [11]. Additionally, it is important to start treating pain in an opiate naïve patient with low doses of medications with short half lives in the acute setting to avoid and monitor for acute reactions [12]. Increasing the dose of a medication is much easier than reacting to an overdose and is much safer for patients; treating an overdose of a medication with a short half-life is much easier and safer than treating an overdose of a medication with a long half-life.…”