A randomized study on oral administration of morphine and methadone in the treatment of cancer pain

Ventafridda, Vittorio; Ripamonti, Carla; Bianchi, Mauro; Sbanotto, Alberto; Conno, F. De

doi:10.1016/s0885-3924(86)80042-2

Cited by 89 publications

(31 citation statements)

References 16 publications

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“…21 The median dose of methadone in our cohort was only 23 mg. Indeed, our dose is a realistic representation of the actual doses used clinically pain control, 7,[28][29][30] and is consistent with current clinical practice. 31 The palliative care approach to pain management over the years has evolved into a true multidisciplinary approach, which includes identifying risk factors for cancer pain, with an emphasis on psychosocial interventions in addition to pharmacotherapy.…”

Section: Discussionsupporting

confidence: 69%

The Effect of Oral Methadone on the QTc Interval in Advanced Cancer Patients: A Prospective Pilot Study

Reddy

Hui

Osta

et al. 2010

Journal of Palliative Medicine

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Background: Recent reports suggest that high doses of methadone may prolong QTc interval and occasionally cause torsades de pointes; however, few of these studies involved the palliative care population. Objective: The purpose of this study was to determine the effect of initiation of methadone on QTc interval in patients with cancer pain seen at the palliative care setting. Methods: We enrolled 100 patients with cancer in this prospective study. Patients were followed clinically and electrocardiographically for QTc changes at baseline, 2, 4, and 8 weeks. Contributing factors for QTc prolongation such as medications, cardiovascular diseases, and electrolytes disturbances were documented. QTc prolongation was defined as greater than 430 ms in males and greater than 450 ms in females, and significant QTc prolongation was defined as QTc interval greater than 25% increase from baseline or 500 ms or more. Results: Electrocardiographic (ECG) assessments were available for 100, 64, 41, and 27 patients at baseline, 2-, 4-, and 8-week follow-up, respectively. At baseline prior to initiation of methadone, 28 (28%) patients had QTc prolongation. Clinically significant increase in QTc occurred in only 1 of 64 (1.6%) patients at week 2, and none at weeks 4 and 8. There was no clinical evidence of torsades de pointes, ventricular fibrillation, or sudden death. QTc prolongation was more frequent among patients with increased baseline QTc interval. Conclusions: Baseline QTc prolongation was common, whereas significant QTc interval 500 ms or more after methadone initiation rarely occurred, with no evidence of clinically significant arrhythmias. This study supports the safety of methadone use for pain control in patients with advanced cancer in the palliative care setting.

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Section: Discussionsupporting

confidence: 69%

The Effect of Oral Methadone on the QTc Interval in Advanced Cancer Patients: A Prospective Pilot Study

Reddy

Hui

Osta

et al. 2010

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…63 Otherwise, no other differences in toxicities or the ability to achieve pain relief were seen. 63 Mercadante et al 64 conducted a prospective randomized study in 40 study patients with advanced cancer who required strong opioids for their pain management and receiving home hospice care. Study patients were treated with sustained-release morphine or methadone in doses titrated to pain relief and administered 2 or 3 times daily according to clinical need.…”

mentioning

confidence: 95%

“…Patients received either morphine or methadone by mouth for 14 days. 63 Both therapies provided clear reductions in pain intensity, there was less stability in analgesia in the morphine arm, and study patients receiving morphine had a higher incidence of dry mouth. 63 Otherwise, no other differences in toxicities or the ability to achieve pain relief were seen.…”

mentioning

confidence: 98%

“…63 Both therapies provided clear reductions in pain intensity, there was less stability in analgesia in the morphine arm, and study patients receiving morphine had a higher incidence of dry mouth. 63 Otherwise, no other differences in toxicities or the ability to achieve pain relief were seen. 63 Mercadante et al 64 conducted a prospective randomized study in 40 study patients with advanced cancer who required strong opioids for their pain management and receiving home hospice care.…”

mentioning

confidence: 98%

“…6,63,64 Ventafridda et al 63 compared methadone with morphine for moderate to severe cancer pain in 54 study patients who had previously been taking step 2 opioids. Patients received either morphine or methadone by mouth for 14 days.…”

mentioning

confidence: 99%

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