Opioid rotation in patients with cancer pain. A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine
Female; Humans; Male; Cohort Studies; Analgesics; Aged; Middle Aged; Drug Administration Schedule; 80 and over; Comparative Study; Administration; Oral; Pain/drug therapy/etiology; retrospective studies; Injections; Dose-Response Relationship; Drug; Hydromorphone/adverse effects/therapeutic use; Methadone/adverse effects/therapeutic use; Morphine/adverse effects/therapeutic use; Neoplasms/complications; Opioid/adverse effects/therapeutic use; Subcutaneous
BACKGROUND. When a change of opioid is considered, equianalgesic dose tables are used. These tables generally propose a dose ratio of 5:1 between morphine and hydromorphone. In the case of a change from subcutaneous hydromorphone to methadone, dose ratios ranging from 1:6 to 1:10 are proposed. The purpose of this study was to review the analgesic dose ratios for methadone compared with hydromorphone. METHODS. In a retrospective study, 48 cases of medication changes from morphine to hydromorphone, and 65 changes between hydromorphone and methadone were identified. the reason for the change, the analgesic dose, and pain intensity were obtained. RESULTS. The dose ratios between morphine and hydromorphone and vice versa were found to be 5.33 and 0.28, respectively (similar to expected results). However, the hydromorphone/methadone ratio was found to be 1.14:1 (5 to 10 times higher than expected). Although the dose ratios of hydromorphone/morphine and vice versa did not change according to a previous opioid dose, the hydromorphone/methadone ratio correlated with total opioid dose (correlation coefficient = 0.41 P < 0.001) and was 1.6 (range, 0.3-14.4) in patients receiving more than 330 mg of hydromorphone per day prior to the change, versus 0.95 (range, 0.2-12.3) in patients receiving ae330 mg of hydromorphone per day (P = 0.023). CONCLUSIONS. These results suggest that only partial tolerance develops between methadone and hydromorphone. Methadone is much more potent than previously described and any change should start at a lower equivalent dose.
Bruera E; Pereira J; Watanabe S; Belzile M; Kuehn N; Hanson J
Cancer
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1002/(SICI)1097-0142(19960815)78:4%3C852::AID-CNCR23%3E3.0.CO" target="_blank" rel="noreferrer">10.1002/(SICI)1097-0142(19960815)78:4%3C852::AID-CNCR23%3E3.0.CO</a>
Subcutaneous clodronate: a study evaluating efficacy in hypercalcemia of malignancy and local toxicity
Female; Humans; Male; Aged; Middle Aged; 80 and over; Injections; Neoplasms/complications; Subcutaneous; Clodronate; Hypercalcemia/drug therapy; Clodronic Acid/administration & dosage/adverse effects
The logistics of administering intravenous bisphosphonates may be problematic in the care of advanced cancer patients, especially in the home setting. Hypodermoclysis is a convenient method of administering fluid via subcutaneous infusion, presently used in the domiciliary setting. Results of the administration of clodronate via this route are reported.
1997
Walker P; Watanabe S; Lawlor P; Hanson J; Pereira J; Bruera E
Annals Of Oncology : Official Journal Of The European Society For Medical Oncology / Esmo
1997
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1023/a:1008274608267" target="_blank" rel="noreferrer">10.1023/a:1008274608267</a>
Palliative care on the net: an online survey of health care professionals
Female; Male; Adult; Questionnaires; Aged; Middle Aged; Computer Communication Networks; Practice; Attitudes; Health Knowledge; Human; Databases; Periodicals; Attitude of Health Personnel; Attitude to Computers; Factual/utilization; Health Personnel/psychology/statistics & numerical data; Information Services/utilization; Internet/utilization; Nurses/psychology/statistics & numerical data; Online Systems/utilization; Pharmacists/psychology/statistics & numerical data; Physicians/psychology/statistics & numerical data; Terminal Care/statistics & numerical data
A survey was conducted to explore Internet use by palliative care health professionals (HCP). The survey was placed on the World Wide Web with an underlying database, and palliative care HCP were invited to participate via a palliative-care-related website, listserv, and newsletter. A total of 417 evaluable responses were received over a four-month period. Of these, 36% indicated they were from physicians and 30% from nurses, a third of respondents were practicing palliative care full time. Although 63% of respondents were from North America, regions from all over the world were represented. Eighty-eight percent of respondents were searching the Internet for clinical information, 80% were using email, 69% were accessing online medical journals, and 59% were subscribers to a palliative-care-related listserv or newsgroup. This survey illustrates the global outreach of the Internet and draws attention to the growing interest in the use of the Internet for education, research, and clinical use. Further development of online resources should address the needs of users. Evaluation of these resources is called for.
2001
Pereira J; Bruera E; Quan H
Journal Of Palliative Care
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article