Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study

Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study

Mercadante S; Casuccio A; Fulfaro F; Groff L; Boffi R; Villari P; Gebbia V; Ripamonti C

Journal Of Clinical Oncology

2001

Female; Humans; Male; Analgesics; Prospective Studies; Middle Aged; Drug Administration Schedule; Non-U.S. Gov't; Research Support; Administration; Oral; Pain/drug therapy; Neoplasms/complications; Methadone/administration & dosage/pharmacology; Morphine/adverse effects/pharmacology; Opioid/administration & dosage/adverse effects/pharmacology

PURPOSE: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. PATIENTS AND METHODS: Fifty-two consecutive cancer patients receiving oral morphine but with uncontrolled pain and/or moderate to severe opioid adverse effects were switched to oral methadone administered every 8 hours using different dose ratios. Intensity of pain and adverse effects were assessed daily, and the symptom distress score (DS) was calculated before and after switching. RESULTS: Data were analyzed for 50 patients. Switching was considered effective in 80% of the patients; results were achieved in an average of 3.65 days. In the 10 patients who switched to methadone because of uncontrolled pain, a significant reduction in pain intensity (P <.005) and an average of a 33% increase in methadone doses necessary (P <.01) were found after an average of 3.5 days. DS significantly decreased from an average of 8.4 to 4.5 (P <.0005). In the 32 patients switching because of uncontrolled pain and morphine-related adverse effects, significant improvement was found in pain intensity (P <.0005), nausea and vomiting (P <.03), constipation (P <.001), and drowsiness (P <.01), but a significant increase in the methadone dose of an average of 20% (P <.004) was required. CONCLUSION: In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option. In the clinical setting of poor pain control, higher doses of methadone are necessary with respect to the equianalgesic calculated dose ratios previously published.

2001

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