TY - JOUR
T1 - Capsules and suppositories of methadone for patients on high-dose opioids for cancer pain
T2 - Clinical and economic considerations
AU - Watanabe, Sharon
AU - Belzile, Michelle
AU - Kuehn, Norma
AU - Hanson, John
AU - Bruera, Eduardo
N1 - Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 1996
Y1 - 1996
N2 - The dose ratio, analgesic efficacy, toxicity and cost of methadone for cancer pain were evaluated in a retrospective review of 50 consecutive patients treated on a Palliative Care Unit. Patients were switched from hydromorphone 267.7±178.8 mg sc per day to custom-made capsules (24) or suppositories (26) of methadone for reasons of uncontrolled pain (24), toxicity (8), both (15) or other (2). The change in opioid occurred over 2.5±3.6 days, with another 4.4±3.7 days required to reach stable methadone dose. The ratio of stable methadone dose to final hydromorphone dose was 1.07±0.9 (oral) and 1.88±1.27 (rectal) (p=0.01). Visual analogue scores for pain intensity (0-100mm) declined from 50.8±22 to 40±20 (p= 0.01). The most frequent toxicities were constipation (46), sedation (42) and nausea (18). Six patients developed respiratory depression. Total cost of treatment was Canadian $116.77±157.17 for methadone capsules and Canadian $105.34±146.35 for methadone suppositories, vs Canadian $3450.51±5098.58 (p=0.0001) for hydromorphone parenteral solution and Canadian $1801.21±2661.52 (p=0.0001) for hydromorphone powder. It is concluded that methadone is an effective and inexpensive alternative in patients receiving high-dose opioids for cancer pain, at dose ratios much lower than recommended in the literature. The incidence of serious toxicities suggests that methadone should only be initiated in an adequately monitored setting by pain management experts.
AB - The dose ratio, analgesic efficacy, toxicity and cost of methadone for cancer pain were evaluated in a retrospective review of 50 consecutive patients treated on a Palliative Care Unit. Patients were switched from hydromorphone 267.7±178.8 mg sc per day to custom-made capsules (24) or suppositories (26) of methadone for reasons of uncontrolled pain (24), toxicity (8), both (15) or other (2). The change in opioid occurred over 2.5±3.6 days, with another 4.4±3.7 days required to reach stable methadone dose. The ratio of stable methadone dose to final hydromorphone dose was 1.07±0.9 (oral) and 1.88±1.27 (rectal) (p=0.01). Visual analogue scores for pain intensity (0-100mm) declined from 50.8±22 to 40±20 (p= 0.01). The most frequent toxicities were constipation (46), sedation (42) and nausea (18). Six patients developed respiratory depression. Total cost of treatment was Canadian $116.77±157.17 for methadone capsules and Canadian $105.34±146.35 for methadone suppositories, vs Canadian $3450.51±5098.58 (p=0.0001) for hydromorphone parenteral solution and Canadian $1801.21±2661.52 (p=0.0001) for hydromorphone powder. It is concluded that methadone is an effective and inexpensive alternative in patients receiving high-dose opioids for cancer pain, at dose ratios much lower than recommended in the literature. The incidence of serious toxicities suggests that methadone should only be initiated in an adequately monitored setting by pain management experts.
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U2 - 10.1016/S0305-7372(96)90075-4
DO - 10.1016/S0305-7372(96)90075-4
M3 - Article
C2 - 8625339
AN - SCOPUS:0029979927
SN - 0305-7372
VL - 22
SP - 131
EP - 136
JO - Cancer treatment reviews
JF - Cancer treatment reviews
IS - SUPPL.1
ER -