The role of methadone in opioid rotation—a Polish experience

Leppert, Wojciech

doi:10.1007/s00520-008-0537-7

Cited by 15 publications

(12 citation statements)

References 43 publications

(58 reference statements)

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“…All patients recovered completely once methadone was discontinued. Respiratory depression appeared in one of 21 patients after morphine to methadone switch because of alprazolam interaction, who recovered after naloxone infusion and methadone discontinuation (139).…”

Section: Adverse Effectsmentioning

confidence: 99%

“…A number of open studies assessed methadone as the second strong opioid in cancer patients rotated from morphine (7,11,17,25,26,37,38,(61)(62)(63)(64)(65)(66)(67)(68)70,76,78,89,94,95,106,107,109,(139)(140)(141), hydromorphone (7,11,37,75,77,95,96,109), fentanyl (8)(9)(10)17,68,72,108,139,142) and other opioids (7,11,77,142). Although no randomised studies were performed (143,144), methadone improves analgesia and adverse effects profile in 46-89% (...…”

Section: Summary Of Methadone Studies In Cancer Painmentioning

confidence: 99%

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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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Section: Adverse Effectsmentioning

confidence: 99%

Section: Summary Of Methadone Studies In Cancer Painmentioning

confidence: 99%

The role of methadone in cancer pain treatment - a review

Leppert

2009

International Journal of Clinical Practice

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“…[100–3106–11118–20122129139144145153158164176180] Among the original articles, there were 12 qualitative studies[115116118–20122124126–8155169–71173] and 56 quantitative studies. [89–99104105112–4117121123125130–8140–3146–52154156157159–63165–8172174175177–9] There were eight randomized clinical trials,[94143150157161162167177] 12 non-randomized clinical trials,[8999113125137147149151163172175178] 11 cohort studies,[9597121123130131133154156165168] zero case-control studies, 10 cross-sectional studies[9396114…”

Section: Resultsmentioning

confidence: 99%

Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals

Kumar

2011

Indian J Palliat Care

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Objective:A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature.Materials and Methods:Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010. The journals included were: American Journal of Hospice and Palliative Care, BMC Palliative Care, Current Opinion in Supportive and Palliative Care, End of Life Care Journal, European Journal of Palliative Care, Hospice Management Advisor, Indian Journal of Palliative Care, International Journal of Palliative Nursing, Internet Journal of Pain Symptom Control and Palliative Care, Journal of Pain and Palliative Care Pharmacotherapy, Journal of Palliative Care, Journal of Palliative Medicine, Journal of Social Work in End-of-life and Palliative Care, Journal of Supportive Oncology, Palliative Medicine, Palliative and Supportive Care, and Supportive Care in Cancer. Journal contents were searched to identify studies that included cancer pain in abstract.Results:During the years 2009 and 2010, of the selected 1,569 articles published in the journals reviewed, only 5.86% (92 articles) were on cancer pain.Conclusion:While researchers in the field of palliative care have studied cancer pain, the total percentage for studies is still a low 5.86%. To move the field of palliative care forward so that appropriate guidelines for cancer pain management can be developed, it is critical that more research be reported upon which to base cancer pain therapy in an evidence-based palliative care model.

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“…56 Switching to methadone, which is another NMDA antagonist, also frequently overcomes opioid tolerance. 57 Finally, tolerance can often be overcome by switching to a different opioid. 58 Common Opioid Side Effects…”

Section: Opioid-induced Tolerance and Hyperalgesiamentioning

confidence: 99%

Pharmacology of Nonsteroidal Antiinflammatory Drugs and Opioids

Slater

Kunnathil

McBride

et al. 2010

Semin intervent Radiol

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Chronic pain affects up to 50 million Americans every day. Traditional treatment has included acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), or opioids. The combination of NSAIDs and opioids can provide effective treatment for up to 90% of patients with chronic pain, but the NSAIDs have the potential for significant, even lifethreatening side effects. Additionally, the nonselective cyclooxygenase inhibitors with 16,000 deaths per year in the United States might not be any safer. The opioids are great for short-term pain, but may need to be adjusted or changed frequently due to the development of tolerance. Understanding of the mechanism of opioids and NSAIDs has improved greatly over the past decade, but is still incomplete.

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The role of methadone in opioid rotation—a Polish experience

Abstract: Results confirmed high analgesic efficacy, acceptable methadone adverse event profile, safety, and effectiveness of ddom to ddomet dose calculation method.

Cited by 15 publications

References 43 publications

The role of methadone in cancer pain treatment - a review

The role of methadone in cancer pain treatment - a review

Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals

Pharmacology of Nonsteroidal Antiinflammatory Drugs and Opioids

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