Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain

Benítez-Rosario, Miguel Ángel; Feria, Manuel; Salinas-Martín, Antonio; Martínez-Castillo, Luis Pedro; Martı́n-Ortega, José Javier

doi:10.1002/cncr.20712

Cited by 69 publications

(58 citation statements)

References 30 publications

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“…Differently from that reported in the literature [2,16,[21][22][23][24]28], the motivation for the change of opioid in our study was not the lack of analgesic control or possible doselimiting side effects. Substitution was performed early in the search of a more comfortable dosage and a lower cost, as the patients were already in chronic use of morphine with stable doses for at least 1 week.…”

Section: Discussioncontrasting

confidence: 69%

Early switching from morphine to methadone is not improved by acetaminophen in the analgesia of oncologic patients: a prospective, randomized, double-blind, placebo-controlled study

Cubero

Giglio

2009

Support Care Cancer

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Objectives This study aims to evaluate the efficacy of methadone as substitute for morphine and to investigate if the addition of acetaminophen could reduce the time to attain an equianalgesic dose of methadone and/or to improve the level of pain control in oncologic patients. Patients and methods Fifty patients on stable doses of morphine for 1 week were switched to methadone using a "stop-start" strategy and randomized in a double-blind fashion to receive either acetaminophen (750 mg PO every 6 hours) or placebo for a 7-day period. We collected data regarding level of pain, side effects, and quality of life. Results Substitution of morphine for methadone resulted in a significant reduction in constipation (p<0.001) and xerostomia (p=0.03). There was also an improvement in the numeric pain scale (p=0.03) as well as a significant improvement in the functional level and symptomatology according to the QLQ-C30 questionnaire. Addition of acetaminophen did not improve pain control or reduce the time of stabilization of analgesia once methadone was introduced. At the end of the study, most patients (70.8%, p=0.001) preferred methadone to morphine. Conclusions Early switching from morphine to methadone was a safe and efficient strategy for the reduction of side effects and improvement of analgesia, allowing for a comfortable dosing regimen. In this scenario, the association with acetaminophen did not improve pain control or reduce the time to achieve an equianalgesic dose of methadone.

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Section: Discussioncontrasting

confidence: 69%

Early switching from morphine to methadone is not improved by acetaminophen in the analgesia of oncologic patients: a prospective, randomized, double-blind, placebo-controlled study

Cubero

Giglio

2009

Support Care Cancer

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“…Methadone, because of its reduced euphoric effect, is used for the chronic treatment of drug addiction [3]. Methadone is also used for the treatment of neuropathic pain, with a marked increase in its use currently [4,5,6,7,8]. However, limiting methadone’s clinical use has been the QT prolongation with the associated arrhythmic risk [9,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Chiral Isolates of Methadone on the Cardiac Potassium Channel IKr

et al. 2008

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Objectives: Methadone is a synthetic opioid, an analgesic and an antiaddictive. QT prolongation as well as torsade de pointes ventricular tachycardia and death have been reported with methadone. Methadone’s proarrhythmic toxicity is related to the inhibition of cardiac IKr channel and prolongation of the action potential. We hypothesized that the 2 isomers of methadone may have different effects on the IKr channel. Methods: The effects of the isomers on IKr were evaluated by using an oocytes system with heterogeneously expressed human ether-a-go-go-related gene (HERG) using the 2 electrode voltage clamp technique. r- and s-methadone were obtained by employing chiral high-performance liquid chromatography, separating methadone into 2 isolates, with optical rotations of –141 and +143 degrees. Results: At concentrations of 0.01, 0.03, 0.1, 1 and 3 mM, r/s-methadone produced a dose-dependent inhibition of HERG by 17 ± 5, 23 ± 4, 40 ± 4, 57 ± 3, 69 ± 3 and 80 ± 1%, respectively. The IC₅₀ of r/s-methadone was 0.21 ± 0.02 mM. At 0.1, 0.3 and 1 mM, s-methadone reduced HERG current by 50 ± 4, 76 ± 5 and 87 ± 5%, respectively, while r-methadone reduced HERG current by 26 ± 4, 53 ± 3 and 77 ± 3%, respectively. Conclusions: There was a significant difference (p < 0.01) in the percentage of current inhibition between r- and s-methadone, at 0.1 and 0.3 mM (52% reduction). Thus, r-methadone may be a safer agent due to less QT effect.

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“…Es wurde auch bei diesem Pferd direkt postoperativ appliziert. Fentanyl ist ebenfalls ein synthetisches Opioid, welches eine 40-bis 80-fach höhere Potenz besitzt als Morphin und auch eine höhere Potenz aufweist als Methadon (Benitez-Rosario et al 2004). Dies war der Grund warum man sich bei diesem Pferd entschieden hat, am ersten Tag postoperativ von Methadon auf Fentanyl zu wechseln.…”

Section: Abbunclassified

Pain management in a horse with severe head trauma

Iff¹,

Auer²,

Mosing³

2009

PHK

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This case report describes the pain management of an eleven year old, female warm blood horse after severe head trauma. The horse was anaesthetised using a balanced anaesthetic protocol to stabilise the mandibular fracture and for wound debridement. Postoperatively the horse received flunixine meglumine intravenously every 12 hours and methadone intramuscularly every 6 hours. Despite this pain management the horse showed obvious discomfort: box walking, pawing, head pressing and lack of appetite. Ketamine was administered subcutaneously and two 100 mcg/h fentanyl-patches were applied to the skin of the dorsal croup after clipping and cleaning of the site. A few hours later the horse was eating and showing decreased signs of discomfort. After the two patches were removed the horse was detoriating again. A further two patches reversed the behavioural signs again. Acupuncture was used in addition to the drugs. Ketamine was discontinued shortly after changing to fentanyl and starting acupuncture treatment. The pain management using fentanyl patches, flunixine and acupuncture was continued for six days postoperatively and the horse was comfortable throughout this time period. The case report reviews and discusses the multimodal analgesic approach for this horse

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Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain

Cited by 69 publications

References 30 publications

Early switching from morphine to methadone is not improved by acetaminophen in the analgesia of oncologic patients: a prospective, randomized, double-blind, placebo-controlled study

Early switching from morphine to methadone is not improved by acetaminophen in the analgesia of oncologic patients: a prospective, randomized, double-blind, placebo-controlled study

The Effects of Chiral Isolates of Methadone on the Cardiac Potassium Channel IKr

Pain management in a horse with severe head trauma

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