The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: A randomized double-blind controlled trial

Mazzocato, Claudia; Buclin, Thierry; Rapin, Charles‐Henri

doi:10.1023/a:1008337624200

Cited by 143 publications

(78 citation statements)

References 16 publications

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“…However, evidence of long-term efficacy is limited and conflicting (241,242). Opioids are associated with frequent side effects (241,243), particularly constipation, but clinically significant respiratory depression is uncommon with the doses used to treat dyspnea, even in elderly patients (244,245). Randomized controlled trials have not found nebulized opioids to be associated with fewer side effects than oral or parenteral opioids (246).…”

Section: Treatmentmentioning

confidence: 99%

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

Parshall¹,

Schwartzstein²,

Adams³

et al. 2012

Am J Respir Crit Care Med

1,505

1,328

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Section: Treatmentmentioning

confidence: 99%

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

Parshall¹,

Schwartzstein²,

Adams³

et al. 2012

Am J Respir Crit Care Med

1,505

1,328

View full text Add to dashboard Cite

“…All of the 2443 patients who received opioids had poor systemic conditions, as indicated by baseline PPS 35 (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The most common tumor type was respiratory tract tumor.…”

Section: Discussionmentioning

confidence: 99%

“…The reasons why morphine accounted for the major part may include that morphine is effective not only for pain relief but also for dyspnea mitigation and useful for terminal cancer patients because of availability at low cost and a variety of dosage forms. 32) Another reason is that oxycodone injection was added to opioids in Japan since 2012. For terminal cancer patients who experienced uncontrollable pain and who had difficulty in taking drugs orally, the subcutaneous or intravenous route is preferable for rapid analgesic effects.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Study on Administration of Opioid Antagonists in Terminal Cancer Patients: 7 Patients Receiving Opioid Antagonists Following Opioids among 2443 Terminal Cancer Patients Receiving Opioids

Uekuzu

Higashiguchi

Futamura

et al. 2017

Biological & Pharmaceutical Bulletin

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There have been few detailed reports on respiratory depression due to overdoses of opioids in terminal cancer patients. We investigated the situation of treatment with opioid antagonists for respiratory depression that occurred after administration of opioid at optimal doses in terminal cancer patients, to clarify pathological changes as well as causative factors. In 2443 terminal cancer patients receiving opioids, 7 patients (0.3%) received opioid antagonists: 6, morphine (hydrochloride, 5; sulfate, 1); 1, oxycodone. The median dosage of opioids was 13.3 mg/d, as converted to morphine injection. Respiratory depression occurred on this daily dose in 4 patients and after changed dose and route in 3 patients. Opioids were given through the vein in 6 patients and by the enteral route in 1 patient. Concomitant drugs included nonsteroidal anti-inflammatory drugs in 3 patients and zoledronic acid in 2 patients. In morphine-receiving patients, renal functions were significantly worsened at the time of administration of an opioid antagonist than the day before the start of opioid administration. These findings indicate that the proper use of opioids was safe and acceptable in almost all terminal cancer patients. In rare cases, however, a risk toward respiratory depression onset is indicated because morphine and morphine-6-glucuronide become relatively excessive owing to systemic debility due to disease progression, especially respiratory and renal dysfunctions. At the onset of respiratory depression, appropriate administration of an opioid antagonist mitigated the symptoms. Thereafter, opioid switching or continuous administration at reduced dosages of the same opioids prevented the occurrence of serious adverse events.

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“…The efficacy of morphine for the palliation of dyspnea in cancer patients is well-documented (14,15), and a recent randomized crossover clinical trial identified that the administration of oral transmucosal fentanyl citrate does not appear to improve exertional dyspnea in patients with advanced cancer, compared with the placebo (16). In lung cancer, the majority of patients exhibit dyspnea in the terminal stage (17).…”

Section: Discussionmentioning

confidence: 99%

Long-term use of a once-a-day fentanyl citrate transdermal patch in lung cancer patients

et al. 2015

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Abstract. Transdermal fentanyl is widely administered as an analgesic therapy for cancer patients. Recently, a novel fentanyl citrate transdermal patch was developed in Japan, which is the first such patch that requires changing only once a day. The patch releases more stable serum fentanyl concentrations and results in less frequent adverse skin symptoms compared with the conventional 72-h transdermal fentanyl patch. A previous study has reported the short-term analgesic effects and safety of this transdermal patch. However, the long-term efficacy has yet to be determined. Therefore, the present study retrospectively investigated the adverse effects and outcomes of treatment with this product in 46 lung cancer patients. In total, 35 (76%) patients were able to continue the treatment until the end of the observation period, including 32 (69%) who succumbed to the disease and three (7%) who were transferred from Nagoya City University Hospital to a hospice. Of the 11 (24%) discontinued cases, six were changed to a course of injectable opioids for the palliation of terminal symptoms, including dyspnea. Adverse effects were observed in 11 (24%) cases, but discontinuation due to adverse effects occurred in only four cases. Therefore, the present study indicates that palliative treatment with the once-a-day fentanyl citrate transdermal patch is well-tolerated by lung cancer patients.

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The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: A randomized double-blind controlled trial

Abstract: Morphine appears effective for cancer dyspnea, and it does not compromise respiratory function at the dose level used.

Cited by 143 publications

References 16 publications

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea

A Clinical Study on Administration of Opioid Antagonists in Terminal Cancer Patients: 7 Patients Receiving Opioid Antagonists Following Opioids among 2443 Terminal Cancer Patients Receiving Opioids

Long-term use of a once-a-day fentanyl citrate transdermal patch in lung cancer patients

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