Switching from oxycodone to methadone in advanced cancer patients

Abstract

Purpose The aim of this study was to prospectively evaluate the outcomes and the conversion ratio of switching from oxycodone to methadone in advanced cancer patients admitted to an acute palliative care unit. Patients and methods A prospective study was carried out on a cohort of consecutive sample of patients receiving oxycodone, who were switched for different reasons mainly because of an inconvenient balance between analgesia and adverse effects. An initial conversion ratio between oxycodone and methadone was 3.3:1. Intensity of pain and symptoms associated with opioid therapy were recorded, and a distress score (DS) was also calculated as a sum of symptom intensity. A successful switching was considered when the intensity of pain and/or DS or the principal symptom requiring switching decreased at least of 33% of the value recorded before switching. Results Nineteen out of 542 patients admitted to the unit in 1 year underwent a switching from oxycodone to methadone.Almost all substitutions were successful. The prevalent indication for opioid switching was uncontrolled pain and adverse effects (12 patients). No significant changes between the initial conversion ratio and final conversion ratio between the two opioids were found. Conclusion Switching from oxycodone to methadone is a reliable method to improve the opioid response in advanced cancer patients. A ratio of 3.3 appears to be reliable, even at high doses. Further studies should be performed to confirm these results in other settings and with very high doses of oxycodone.

Morphine or Oxycodone for Cancer-Related Pain? A Randomized, Open-Label, Controlled Trial

“…Some studies have used protocol-defined cutoff points for pain and adverse effect intensity to determine opioid dosing and switching. 14,20 In this study, there was a wide range of reported analgesic and side-effect scores in both opioid responders and nonresponders. It is thus difficult, if not impossible, to choose specific thresholds to define opioid response because of the high variability within the study population, a finding mirrored in other studies.…”

“…These assessments were in line with other studies in this area. 20,21 Pain was assessed using the Brief Pain Inventory, 22 which is validated and widely used. For each of the five pain modalities, …”

Differences between opioids: pharmacological, experimental, clinical and economical perspectives

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Perbedaan Pengaruh Morphin Controlled Release 30 mg dan Oxycodone Controlled Release 20 mg Oral terhadap Nyeri Kanker

“…Penelitian lainnya Mercadente dkk. 15 menunjukkan VAS pada tiap-tiap kelompok tidak berbeda bermakna pada nyeri kanker pankreas. Hal yang sama juga menunjukkan tidak ada perbedaan antara morfin dan oksikodon terhadap nyeri sedang sampai pasien kanker.…”