Opioids for management of episodic breathlessness or dyspnea in patients with advanced disease

Cabezón-Gutiérrez, Luis; Khosravi-Shahi, Parham; Custodio-Cabello, Sara; Muñiz-González, Francisco; Cano-Aguirre, Maria Del Puerto; Alonso-Viteri, Soledad

doi:10.1007/s00520-016-3316-x

Cited by 21 publications

(7 citation statements)

References 46 publications

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“…Our findings are consistent with other reviews on opioids for chronic breathlessness [5, 6, 86] and episodic breathlessness [87]. These reviews included RCTs [5,6,86,87], NRTs [6,86] and case reports [87].…”

Section: Discussionsupporting

confidence: 92%

Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

et al. 2017

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Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. The aim of this study was to systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness.PubMed, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible.We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in carbon dioxide tension (0.27 kPa, 95% CI 0.08-0.45 kPa,) and no significant change in oxygen tension and oxygen saturation (both p>0.05). Nonserious respiratory depression (definition variable/not stated) was described in four out of 1064 patients. One cancer patient pretreated with morphine for pain needed temporary respiratory support following nebulised morphine for breathlessness (single case study).We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed.

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Section: Discussionsupporting

confidence: 92%

Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

et al. 2017

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“…Dosage regimens, as presented in the opinion from the CONTAM Panel from 2011, are confirmed in recent reviews and monographs (e.g. Currow et al., ; Kohberg et al., ; Cabezon‐Gutierrez et al., ; Martindale, ). However, in newer literature, further research needs are suggested to investigate upwards titration of dosages under aspects of therapeutical benefits and reduction of adverse effects (Currow et al., ; Verberkt et al., ).…”

Section: Assessmentmentioning

confidence: 67%

Update of the Scientific Opinion on opium alkaloids in poppy seeds

Knutsen¹,

Alexander²,

Barregård³

et al. 2018

EFS2

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Poppy seeds are obtained from the opium poppy (Papaver somniferum L.). They are used as food and to produce edible oil. The opium poppy plant contains narcotic alkaloids such as morphine and codeine. Poppy seeds do not contain the opium alkaloids, but can become contaminated with alkaloids as a result of pest damage and during harvesting. The European Commission asked EFSA to provide an update of the Scientific Opinion on opium alkaloids in poppy seeds. The assessment is based on data on morphine, codeine, thebaine, oripavine, noscapine and papaverine in poppy seed samples. The CONTAM Panel confirms the acute reference dose (ARfD) of 10 lg morphine/kg body weight (bw) and concluded that the concentration of codeine in the poppy seed samples should be taken into account by converting codeine to morphine equivalents, using a factor of 0.2. The ARfD is therefore a group ARfD for morphine and codeine, expressed in morphine equivalents. Mean and high levels of dietary exposure to morphine equivalents from poppy seeds considered to have high levels of opium alkaloids (i.e. poppy seeds from varieties primarily grown for pharmaceutical use) exceed the ARfD in most age groups. For poppy seeds considered to have relatively low concentrations of opium alkaloids (i.e. primarily varieties for food use), some exceedance of the ARfD is also seen at high levels of dietary exposure in most surveys. For noscapine and papaverine, the available data do not allow making a hazard characterisation. However, comparison of the dietary exposure to the recommended therapeutical doses does not suggest a health concern for these alkaloids. For thebaine and oripavine, no risk characterisation was done due to insufficient data. However, for thebaine, limited evidence indicates a higher acute lethality than for morphine and the estimated exposure could present a health risk.

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“…8,[14][15][16][17] For example, oxycodone and fentanyl are potential substitutes for morphine in the palliative treatment of dyspnea. [9][10][11][18][19][20][21][22][23] There are a variety of efficacious ways to administer opioids for breathlessness relief. Oral and parenteral opioid formulations are particularly successful in minimizing dyspnea.…”

Section: Subheading Of "Pharmacologic Management: Opioids": Morphine ...mentioning

confidence: 99%

Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

Zemel

2021

Am J Hosp Palliat Care

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As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients’ dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.

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Opioids for management of episodic breathlessness or dyspnea in patients with advanced disease

Cited by 21 publications

References 46 publications

Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

Update of the Scientific Opinion on opium alkaloids in poppy seeds

Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

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