Methadone titration in opioid-resistant cancer pain

Title

Methadone titration in opioid-resistant cancer pain

Creator

Scholes CF; Gonty N; Trotman IF

Publisher

European Journal Of Cancer Care

Date

1999

Subject

Female; Male; Pain Measurement; Adult; Analgesics; Aged; Therapeutic Equivalency; Drug Administration Schedule; 80 and over; Administration; Oral; Drug Tolerance; Human; Drug Resistance; Middle Age; Neoplasms/complications; Morphine/administration & dosage; Methadone/administration & dosage; Opioid/administration & dosage; Pain/diagnosis/drug therapy/etiology

Description

AIM: To assess the use of methadone in patients with cancer pain who fail to respond to increasing doses of other opioids or experience intolerable side-effects from them. METHOD: Inpatients of a specialist palliative care unit were titrated onto oral methadone. The dose was calculated as 10% of the previous morphine equivalent dose, up to maximum of 40 mg, given every 3 h as required for analgesia. When daily requirements were stable it was divided into two regular doses. Pain was assessed on a five-point verbal rating score (VRS): a good response was defined as a fall in VRS of two points or more. Results are expressed as median (range). RESULTS: Thirty-three patients (13 men, 20 women, age 61 (34-91) years), 26 with inadequate analgesia and seven with intolerable opioid related side-effects, were converted to methadone from diamorphine (12), morphine (19) or fentanyl (two). Morphine equivalent dose was 480 (20-1200) mg/day prior to titration. Pain was neuropathic (11), nociceptive (three) or mixed (19). Stabilisation on methadone was complete in 3 (2-18) days in 29 (88%) patients at 80 (20-360) mg/day. Twenty-six (78%) had a good response. Four (12%) patients were withdrawn during titration (three entered terminal phase, one failed to respond). During follow-up 15 (45%) required alteration of methadone dose. Twenty-three (70%) patients were discharged home at 12 (4-26) days. In all cases the stable dose of methadone was less than the previous morphine equivalent, and there was a weak correlation between them. CONCLUSIONS: This method of methadone titration often results in improved pain control in patients with morphine resistance or intolerance. It requires careful titration in a specialist inpatient unit as there is no reliable formula for dose equivalence.
1999

Rights

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).

Type

Journal Article

Citation

Scholes CF; Gonty N; Trotman IF, “Methadone titration in opioid-resistant cancer pain,” Pediatric Palliative Care Library, accessed April 21, 2024, https://pedpalascnetlibrary.omeka.net/items/show/11674.