Intravenous Methadone for Severe Cancer Pain: A Presentation of 10 Cases

Abstract

Purpose. Methadone, a synthetic opioid agonist, is an effective alternative to strong opioids (morphine, hydromorphone, oxycodone, and buprenorphine) and is widely available as an oral formulation. Few data have been published so far on the use of intravenous (i.v.) methadone for the management of severe or refractory cancer pain. Methods. We followed 10 consecutives cancer patients with severe pain, treated with IV methadone. All had advanced disease and had already received strong opioids, some in association with ketamine. Pain was assessed at T0, T24 hours, and at the end of the treatment. Results. All patients benefited from the switch to IV methadone with a reduction of pain on VAS after 24 hours (median: 4/10; range 0–5) until the end of the treatment (all cases <3/10). The median starting dose was 100 mg/day (range 20–400) and the final dose remained stable with a median of 100 mg/day (range 27–700). The median duration of IV methadone was 11 days (range 2–59). No cardiac toxicity had been observed. Conclusions. IV methadone is an effective pain relieving alternative for the treatment of severe cancer pain, especially in refractory pain syndrome. Moreover, we did not observe any toxicity (neurological or cardiac) or any other major side effects and the treatment was overall well tolerated. More extensive comparative studies should be planned.

Buprenorphine, Norbuprenorphine, R-Methadone, and S-Methadone Upregulate BCRP/ABCG2 Expression by Activating Aryl Hydrocarbon Receptor in Human Placental Trophoblasts

“…BUP and MET could be chronically used to treat drug abuse among patients who have cancers or are HIV-infected and thus need to take other medications simultaneously. In addition, BUP and MET are strong opioid agonists used as fourth-line analgesics in cancer patients, and BUP has been suggested as a better analgesic than MET (Nicholson, 2004;Lossignol et al, 2012;SchmidtHansen et al, 2015). BCRP confers multidrug resistance in cancers and decreases absorption or facilitates elimination of anticancer drugs such as topotecan, irinotecan, and flavopiridol, which are BCRP substrates (Mao and Unadkat, 2015).…”