The clinical use of methadone in cancer and chronic pain medicine

Rajan, J; Scott-Warren, Julian

doi:10.1093/bjaceaccp/mkv023

Cited by 7 publications

(3 citation statements)

References 13 publications

(8 reference statements)

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Section: Introductionmentioning

confidence: 99%

“…Methadone is long-acting synthetic opium used as an alternative to treat drug dependence and chronic pain (1). When administered orally, it is absorbed rapidly and completely and is detected in plasma about 30 -60 minutes after oral administration (1). The half-life of the drug is 22 -36 hours up to 59 -90 hours, and therefore, in pain relief, it is superior to other opium, such as morphine and fentanyl, with half-life of 2 to 3 hours and 4 hours, respectively (1).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Intravenous Vitamin C on Serum Level and Urinary Excretion of Methadone in Patients with Methadone Poisoning: A Randomized Single-Blind Clinical Trial

Ghiasi,

Khalighi,

Sadat Hashemi

et al. 2024

Int J High Risk Behav Addict

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Background: Methadone poisoning intentionally or accidentally leads to a high rate of treatment burden and cost and deaths. The evaluation of the factors affecting the severity of poisoning can reduce recovery time, costs, and potential risks. Objectives: This study aimed to investigate the effect of intravenous vitamin C (ascorbic acid) administration on serum level and urinary excretion of methadone. Methods: In this single-blind study, 54 patients who were diagnosed with methadone poisoning were divided into three groups. The two intervention groups received different doses of vitamin C, including 12 and 24 g, and the control group received normal saline. The serum methadone level and urine pH were measured at the time of arrival and 24 hours after admission. The data were analyzed using repeated measure analysis of variance (ANOVA) in STATA version 12. Results: In this study, 18 patients were placed in each group. The three groups were not significantly different in basic variables, such as age, gender, and methadone dosage. Between and within-group comparison showed a significant decrease in the serum methadone levels over time after adjusting age, gender and methadone dosage (P < 0.05). Post-hoc analyses revealed a significant difference in methadone reduction between 12 g of vitamin C and control groups (P = 0.04), and there was no significant difference between the control and 24 g of vitamin C groups (P > 0.05). However, between and within-group comparisons showed no significant difference between the three groups in terms of urine pH (P > 0.05). In addition, interaction was observed between intervention and time on serum methadone levels (P < 0.001) and urine pH (P = 0.04) variables. Conclusions: Consuming 12 g of vitamin C further reduced the serum methadone level in patients with methadone poisoning. There was no effect on methadone urinary excretion in patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Intravenous Vitamin C on Serum Level and Urinary Excretion of Methadone in Patients with Methadone Poisoning: A Randomized Single-Blind Clinical Trial

Ghiasi,

Khalighi,

Sadat Hashemi

et al. 2024

Int J High Risk Behav Addict

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“…Methadone (MTD) is a synthetic opioid with primarily a μ and δ opioid agonist action, but some other novel mechanisms implied in pain relief such as antagonism of the N-methyl-D-aspartate (NMDA) receptor, and inhibition of serotonin and norepinephrine reuptake are also reported in the literature [1][2][3][4][5]. These multiple receptor activities make it an attractive choice for analgesia.…”

Section: Introductionmentioning

confidence: 99%

Revisiting Pharmacokinetics and Pharmacogenetics of Methadone in Healthy Volunteers

Guevara¹,

Lorier²,

Vázquez³

et al. 2020

Drug Discovery and Development - New Advances

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Methadone acts as a μ opioid agonist, a serotonin and norepinephrine reuptake inhibitor, and a noncompetitive N-methyl-D-aspartate receptor antagonist. These actions altogether are responsible for its efficacy in the management of chronic pain. It is available as a racemic mixture of (R)-and (S)-methadone, both being stereoisomers responsible for its analgesic effect. Methadone elimination occurs mainly through metabolism in the liver by CYP3A4, CYP2B6, and CY2C19 and to a lesser extent by CYP2D6 and in the intestine by CYP3A4. The relative intestinal content of CYP2B6 and CY2C19 is unknown but it seems that CYP2B6 is not present at the intestine. CYP3A4, CYP2B6, and CYP2C19 convert methadone mainly into 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine(EDDP). CYP2B6 and CYP2C19 are stereoselective to Sand R-enantiomer, respectively. The pharmacokinetic study carried out in healthy volunteers by our research group confirmed that MTD undergoes recirculation via gastric secretion and intestinal reabsorption and revealed that the drug is extensively metabolized in the liver but intestinal metabolism is not only relevant but also stereoselective. Polymorphisms of the CYP2B6 and CYP2C19 isoenzymes and their relationship with the pharmacokinetics of MTD were also assessed.

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Management of Non-achalasia Esophageal Hypercontractility: EGJ Outflow Obstruction and Hypercontractile Esophagus

Vahedi

Low²,

Yadlapati³

2023

Curr Treat Options Gastro

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The clinical use of methadone in cancer and chronic pain medicine

Cited by 7 publications

References 13 publications

Effect of Intravenous Vitamin C on Serum Level and Urinary Excretion of Methadone in Patients with Methadone Poisoning: A Randomized Single-Blind Clinical Trial

Effect of Intravenous Vitamin C on Serum Level and Urinary Excretion of Methadone in Patients with Methadone Poisoning: A Randomized Single-Blind Clinical Trial

Revisiting Pharmacokinetics and Pharmacogenetics of Methadone in Healthy Volunteers

Management of Non-achalasia Esophageal Hypercontractility: EGJ Outflow Obstruction and Hypercontractile Esophagus

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