Alternative Routes to Oral Opioid Administration in Palliative Care: A Review and Clinical Summary

Kestenbaum, Matthew; Vilches, Agustin O.; Messersmith, Stephanie; Connor, Stephen R.; Fine, Perry G.; Murphy, Brian S.; Davis, Malene S.; Muir, J. Cameron

doi:10.1111/pme.12464

Cited by 38 publications

(18 citation statements)

References 141 publications

(188 reference statements)

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“…Oral administration of drugs may be a good alternative to other routes as it is noninvasive, easy to administer and may produce less pronounced adverse effects (Kestenbaum et al, 2014). Previous studies reported administration of lipid-soluble and water-soluble opioids in horses, such as sublingual buprenorphine (Messenger et al, 2011), oral methadone (Linardi et al, 2009(Linardi et al, , 2012 and oral tramadol (Shilo et al, 2008;Cox et al, 2010;Guedes et al, 2013), but there is no information about possible antinociceptive effects using oral or buccal opioids in such species.…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics and pharmacodynamics of the injectable formulation of methadone hydrochloride and methadone in lipid nanocarriers administered orally to horses

Crosignani

Luna

Costa

et al. 2017

Vet Pharm & Therapeutics

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We investigated the thermal, electrical and mechanical antinociceptive and physiological effects (heart rate, respiratory rate, arterial blood pressure, head height and abdominal auscultation score), and pharmacokinetics, of 0.5 mg/kg of the injectable formulation (ORAL) or nanoparticulated methadone (NANO) given orally, in six adult mares, using a crossover, blind and prospective design. Repeated-measure models were used to compare parametric data between and within treatments, followed by Tukey's test. Nonparametric data were analysed with Wilcoxon signed-rank, adjusted by Bonferroni tests. Blood samples were also collected up to 6 h after dosing for plasma drug quantification by LC-MS/MS. Methadone pharmacokinetic parameters were determined by noncompartmental and compartmental approaches. There were no differences in pharmacodynamic parameters. No statistical differences were observed in the pharmacokinetic parameters from noncompartmental analysis for both groups, except a significant decrease in peak plasma concentration, increase in apparent volume of distribution per fraction absorbed (Vd /F) and increased mean residence time (MRT) for NANO. One-compartment open model with first order elimination best described the pharmacokinetic profiles for both groups. Neither ORAL nor NANO administered orally to horses produced antinociception. The nanoencapsulated formulation of methadone given orally to horses did not improve methadone pharmacokinetic parameters or increased systemic body exposure to methadone.

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Section: Introductionmentioning

confidence: 99%

Pharmacokinetics and pharmacodynamics of the injectable formulation of methadone hydrochloride and methadone in lipid nanocarriers administered orally to horses

Crosignani

Luna

Costa

et al. 2017

Vet Pharm & Therapeutics

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“…While important and often essential in this group of patients, opioids are also a potential cause of adverse events and should be used with caution. ( 32 ) Conversely, terminal sedation was found to be limited to a few cases. This was not surprising, as terminal sedation is a last resource strategy for management of refractory symptoms and pain.…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory characteristics associated with referral of hospitalized elderly to palliative care

Arcanjo

Saporetti

Curiati

et al. 2018

Einstein (São Paulo)

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ObjectiveTo investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care.MethodsA retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care.ResultsExclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care.ConclusionAdvanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.

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“…As patients approach end of life, up to 70% of patients require a nonoral route (NPO) for opioid administration. 21 Dysphagia and mucositis can occur in head and neck, esophageal, and gastric cancers and can be a key barrier to optimal palliation of pain. Neuromuscular and sensory damage due to combined chemother-apy, radiation, and surgery can affect any stage of the swallowing mechanism.…”

Section: Opportunities For Tirfs In the Palliative Care Settingmentioning

confidence: 99%

Transmucosal Immediate-Release Fentanyl for Breakthrough Cancer Pain: Opportunities and Challenges for Use in Palliative Care

Chang¹,

Roeland²,

Atayee³

et al. 2015

Journal of Pain & Palliative Care Pharmacotherapy

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Opioids are used to treat breakthrough cancer pain (BTCP) and can be classified by relative duration and onset of action. Regulatory approvals of numerous transmucosal immediate-release fentanyl (TIRF) formulations provide alternative options to palliative care-trained providers in the management of BTCP. TIRFs have been formulated as a sublingual tablet, sublingual spray, intranasal spray, pectin-based nasal spray, buccal tablet, and buccal soluble film. Differences exist between TIRFs regarding formulation design and dosing to treat BTCP. Opportunities for use include palliation of BTCP in head and neck cancer and/or radiation-induced mucositis. The purpose of this review is to discuss TIRF formulation and dosing, pharmacokinetics, clinical efficacy, patient acceptability, and safety/tolerability. In addition, barriers to TIRF utilization will be discussed.

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Alternative Routes to Oral Opioid Administration in Palliative Care: A Review and Clinical Summary

Cited by 38 publications

References 141 publications

Pharmacokinetics and pharmacodynamics of the injectable formulation of methadone hydrochloride and methadone in lipid nanocarriers administered orally to horses

Pharmacokinetics and pharmacodynamics of the injectable formulation of methadone hydrochloride and methadone in lipid nanocarriers administered orally to horses

Clinical and laboratory characteristics associated with referral of hospitalized elderly to palliative care

Transmucosal Immediate-Release Fentanyl for Breakthrough Cancer Pain: Opportunities and Challenges for Use in Palliative Care

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