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Journal Article |
The role of methadone in cancer pain treatment - Polish experience
Leppert W, Luczak J
Prog Palliat Care 2005;13(5):269-276
Background: In an open, prospective, clinical study, analgesia and the side-effects of methadone were assessed. In addition, the authors' method for the calculation of equi-analgesic doses of oral morphine and methadone was appraised. Patients and methods: Methadone was administered in 14 opioid-tolerant patients with severe cancer pain. Patients received methadone because of inadequate analgesia (NRS > 6) during treatment with morphine (4 patients), transdermal fentanyl [TF] (3), morphine and TF (1), morphine, ketamine and TF (1), tramadol (1), unsatisfactory analgesia with severe drowsiness during morphine with ketamine treatment (3) and very strong pain with nausea during morphine treatment (1). We used the following dose ratios while converting equivalent daily dose of oral morphine (EDDOM) to starting daily dose of oral methadone (SDDOMET) - 4:1 (up to 100 mg EDDOM); 6:1 (100-300 mg EDDOM); and 12:1 (EDDOM over 300 mg); however, in this study, because EDDOM was over 100 mg in all patients, we applied only the last two dose ratios. In 4 patients we used the ratio 25:1 instead of 12:1 because of the very high EDDOM before the switch to methadone (in 3 patients 1500 mg and in 1 patient 600 mg). The SDDOMET in the patient treated with tramadol was 9 mg. The single dose of oral methadone did not exceed 30 mg regardless of the EDDOM before the switch to methadone. After starting methadone, we withdrew previous opioid treatment completely in 12 patients and 2 patients were treated concomitantly with methadone and other opioids. The mean EDDOM before switching to methadone was 736.43 +/- 495.42 mg (median, 700 mg). Methadone was administered 3 times a day and 13 patients were treated with oral methadone in water solution or syrup, 1 patient received the drug rectally in suppositories. Results: The mean time of the methadone treatment was 36.79 +/- 25.37 days (range, 7-92 days; median, 29.5 days) and the starting doses were increased in 12 of 14 treated patients. The mean daily doses varied from 45.93 +/- 19.26 mg at the beginning till maximal 138.14 +/- 104.43 mg and 121.14 +/- 105.19 mg at the end of methadone treatment. Good analgesia (NRS < 4) was achieved in 7 patients, partial effect (NRS 4-6) in 6 patients, and unsatisfactory analgesia (NRS > 6) was observed in 1 patient who stopped methadone after 7 days of treatment. The most frequent side effects were drowsiness (6 patients), constipation (6 patients), nausea and vomiting (2 patients) and sweating (2 patients). We did not observe serious adverse reactions especially respiratory depression, which would cause cessation of the treatment. Conclusions: Results of this preliminary study confirmed the high analgesic efficacy and good adverse event profile of methadone. Although the applied method of oral morphine to methadone dose calculation was safe and effective, it should be confirmed in a larger study.
[ Indexed for EMBASE ID: 2005568799 ]
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