Opioid Rotation to Methadone at Home

Hernansanz, S.; Gutiérrez, Celia; Rubiales, Álvaro Sanz; Flores, Luis Alberto; Valle, María Luisa del

doi:10.1016/j.jpainsymman.2005.12.005

Cited by 15 publications

(18 citation statements)

References 5 publications

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“…Ten patients improved after switching to methadone, but one patient developed severe delayed toxicity, and another one received an initial dose 10 times higher than that prescribed for four days. 20 There are other data pertinent to outpatient switching to methadone. In a retrospective analysis of 29 heavily pretreated patients, the starting dose of methadone was about 25 mg and the final dose after titration was 243 mg.…”

Section: Discussionmentioning

confidence: 99%

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

Mercadante

Valle²,

Porzio³

et al. 2013

Journal of Pain and Symptom Management

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Context. Opioid switching has been found to improve opioid responsiveness in different conditions. However, data on opioid switching performed at home are almost nonexistent, despite the fact that most patients are followed at home.Objectives. The aim of this retrospective survey was to determine frequency, indications, usefulness, and safety of opioid switching when treating advanced cancer-related pain in patients followed at home.Methods. A retrospective review of data from patients with advanced cancer followed at home by three home care teams for a period of two years was performed. Patients who had their opioids switched were selected. Reasons for switching opioid doses and routes of administration and outcomes were collected.Results. Two hundred one (17%) of 1141 patients receiving ''strong'' opioids were switched. The mean Karnofsky Performance Status score was 35.6, and the median survival was 30 days. The most frequent reason to switch was for convenience, and the most frequent switch was to parenteral morphine. In most patients, a better analgesic response was observed. Patients who were switched to parenteral morphine had a shorter survival in comparison with other opioid sequences (P < 0.0005). After switching, opioid doses were increased by 23% and 41%, after a week and at time of death, respectively.Conclusion. Opioid switching was useful for most patients in the home environment, at least in less complex circumstances, when done by experienced home care teams. Prospective studies are needed to provide information about the decision to admit to hospital for this purpose and the predictive factors that may relatively contraindicate transportation to a facility in severely ill patients. J Pain Symptom Manage 2013;45:298e304. Ó

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Section: Discussionmentioning

confidence: 99%

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

Mercadante

Valle²,

Porzio³

et al. 2013

Journal of Pain and Symptom Management

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“…Although methadone dose titration during OR is performed usually at the in‐patient unit (82), Hernansanz et al. (83) advocate OR to methadone to be performed at home with 24 h access to possible naloxone administration in case of respiratory depression. Table 3 presents an overview of equianalgesic dose ratio of morphine and methadone.…”

Section: Equianalgesic Dose Ratio With Other Opioidsmentioning

confidence: 99%

The role of methadone in cancer pain treatment - a review

Leppert

2009

International Journal of Clinical Practice

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Summary Background: Methadone is an opioid analgesic of step 3 of the World Health Organization (WHO) analgesic ladder. Aim and Methods: To outline pharmacodynamics, pharmacokinetics, drug interactions, equianalgesic dose ratio with other opioids, dosing rules, adverse effects and methadone clinical studies in patients with cancer pain. A review of relevant literature on methadone use in cancer pain was conducted. Results: Methadone is used in opioid rotation and administered to patients with cancer pain not responsive to morphine or other strong opioids when intractable opioid adverse effects appear. Methadone is considered as the first strong opioid analgesic and in patients with renal impairment. Methadone possesses different pharmacodynamics and pharmacokinetics in comparison to other opioids. The advantages of methadone include multimode analgesic activity, high oral and rectal bioavailability, long lasting analgesia, lack of active metabolites, excretion mainly with faeces, low cost and a weak immunosuppressive effect. The disadvantages include long and changeable plasma half‐life, high bound to serum proteins, metabolism through P450 system, numerous drug interactions, lack of clear equianalgesic dose ratio to other opioids, QT interval prolongation, local reactions when administered subcutaneously. Conclusions: Methadone is an important opioid analgesic at step 3 of the WHO analgesic ladder. Future controlled studies may focus on establishment of methadone equianalgesic dose ratio with other opioids and its role as the first strong opioid in comparative studies with analgesia, adverse effects and quality of life taken into consideration.

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“…Unfortunately, there are few reports 16, 17 on the initiation and/or rotation of methadone in the outpatient setting for cancer pain. The objective of this retrospective study was to determine the efficacy and safety of methadone initiation (in strong opioid naïve patients) or rotation from another strong opioid in treating cancer-related pain in an outpatient palliative care clinic at a comprehensive cancer center.…”

Section: Introductionmentioning

confidence: 99%

Methadone initiation and rotation in the outpatient setting for patients with cancer pain

Parsons¹,

Cruz²,

Osta³

et al. 2009

Cancer

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BACKGROUND:Methadone is an effective and inexpensive opioid for cancer pain treatment. It has been reported as difficult to use in the outpatient setting because of its variable relative potency and long half-life. The purpose of this study was to determine the outcome of methadone initiation or rotation for cancer pain treatment in outpatient settings. METHODS: Chart review was done of 189 consecutive patients who underwent methadone initiation or rotation at the authors' palliative care outpatient center. Data were collected regarding demographic and clinical characteristics, symptoms, and opioid side effects at baseline and for 2 follow-up visits (F1, F2). Failure was defined as methadone discontinuation by the palliative care physician or patient's hospitalization for uncontrolled pain or methadonerelated side effects at F1. RESULTS: One hundred (53%) initiations and 89 (47%) rotations were conducted. Success rates for methadone initiation and rotation were 82 of 89 (92%) and 85 of 100 (84%), respectively. Mean (standard deviation) age was 60 (11) years. One hundred (53%) patients were women, 138 (73%) were white, and 182 (96%) had solid cancers. The main reason for rotation was pain (65 of 89 patients, 47%). Median (interquartile range, IQR) pain scores (Edmonton Symptom Assessment Scale/0-10) were 6 (5-8), 4 (3-6), and 3 (2-5) at baseline, F1, and F2, respectively (P < .0001). Median (IQR) daily methadone dose for initiation and rotation was 10 (5-15) mg and 15 (10-30) mg at F1 (P < .0001) and 10 (8-15) mg and 18 (10-30) mg at F2 (P < .0001), respectively. Constipation and nausea improved (P < .005) after initiation/rotation to methadone. Frequency of sedation, hallucinations, myoclonus, and delirium did not increase after initiation/rotation to methadone. CONCLUSIONS: Outpatient methadone initiation and rotation for cancer pain treatment were safe, with high success rates and low side effect profiles. Cancer 2010;116:520-8.

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Opioid Rotation to Methadone at Home

Cited by 15 publications

References 5 publications

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

Opioid Switching in Patients With Advanced Cancer Followed at Home. A Retrospective Analysis

The role of methadone in cancer pain treatment - a review

Methadone initiation and rotation in the outpatient setting for patients with cancer pain

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