Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T04:46:22.250Z Has data issue: false hasContentIssue false
  • English
  • Français

Consensus guideline on parenteral methadone use in pain and palliative care

Published online by Cambridge University Press:  23 May 2008

Lauren Shaiova ,
Ann Berger ,
Craig D. Blinderman ,
Eduardo Bruera ,
Mellar P. Davis ,
Susan Derby ,
Charles Inturrisi ,
Jill Kalman ,
Davendra Mehta  and
Marco Pappagallo
...Show all authors
Lauren Shaiova*
Affiliation:
Pain and Palliative Care Physician, Bethesda, Maryland
Ann Berger
Affiliation:
Palliative Care Service, Department of Medicine, Massachusetts General Hospital and the Harvard Medical School Center for Palliative Care, Boston, Massachusetts
Craig D. Blinderman
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
Eduardo Bruera
Affiliation:
Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Mellar P. Davis
Affiliation:
Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center, New York, New York
Susan Derby
Affiliation:
Weill Cornell Medical College, New York, New York
Charles Inturrisi
Affiliation:
Cardiovascular Institute, Mount Sinai Medical Center, New York, New York
Jill Kalman
Affiliation:
Section of Cardiac Electrophysiology, Mount Sinai Hospital and School of Medicine, New York, New York
Davendra Mehta
Affiliation:
Mount Sinai School of Medicine, New York, New York
Marco Pappagallo
Affiliation:
Visiting Nurse Service of New York Hospice Care, New York, New York
Eugene Perlov
Affiliation:
Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Lauren Shaiova, Department of Pain Medicine and Palliative Care, Metropolitan Hospital Center, Health and Hospital Corporation of New York City; 1901 First Ave. New York, NY 10029. E-mail: [email protected] or [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Once used only as third-line therapy for chronic pain management, methadone is now being used as first- and second-line therapy in palliative care. The risks and stigma associated with methadone use are known, but difficulties with dosing methadone and lack of an established conversion protocol from other opiates have limited the access for patient populations who could potentially benefit from this medication. For palliative care patients, the benefits of methadone can far outweigh its risks. This article provides an overview and specific recommendations on the use of parenteral methadone in pain and palliative care, with a focus on the transition from hospital to home/hospice care. The goal of this consensus guideline is to assist clinicians who are providing chronic pain management in acute care hospital and nonhospital settings (i.e., hospice, long-term care facilities, and community) for patients with life-limiting illnesses, where the goals of care are focused on comfort (i.e., palliative care). The recommendations in this article intend to promote a standard of care involving the use of intravenous methadone with the aim of reaching a broader population of patients for whom this drug would provide important benefits.

Keywords

AnalgesiaPalliative carePainAnalgesicsOpioidIntravenous methadone
Type
Review Articles
Information
Palliative & Supportive Care , Volume 6 , Issue 2 , June 2008 , pp. 165 - 176
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Al-Khatib, S.M., LaPointe, N.M., Kramer, J.M., et al. (2003). What clinicians should know about QT interval. Journal of the American Medical Association, 289, 2120–2127.Google ScholarPubMed
Anderson, M.E., Al-Khatib, S.M., Roden, D.M., et al. (2002). Cardiac repolarization: Current knowledge, critical gaps, and new approaches to drug development and patient management. American Heart Journal, 144, 769–781.CrossRefGoogle ScholarPubMed
Auret, K., Roger Goucke, C., Ilett, K.F., et al. (2006). Pharmacokinetics and pharmacodynamics of methadone enantiomers in hospice patients with cancer pain. Therapeutic Drug Monitoring, 28, 359–366.CrossRefGoogle ScholarPubMed
Centeno, C. & Vara, F. (2005). Intermittent subcutaneous methadone administration in the management of cancer pain. Journal of Pain Palliative Care Pharmacotherapy, 19(2), 7–12.CrossRefGoogle ScholarPubMed
Derby, S., Chin, J., & Portenoy, R.K. (1998). Systemic opioid therapy for chronic cancer pain: Practical guidelines for converting drugs and routes of adminsistration. CNS Drugs, 9, 99–109.Google Scholar
Drug Facts and Comparisons. (2007), p. 1082. St. Louis: Wolters-Kluwer Health.Google Scholar
Dyer, K.R. & White, J.M. (1997). Patterns of symptoms complaints in methadone maintenance patients. Addiction, 92, 1445–1455.CrossRefGoogle ScholarPubMed
Ehret, G.B., Voide, C., Gex-Fabry, M., et al. (2006). Drug-induced long QT syndrome in injection drug users receiving methadone: High frequency in hospitalized patients and risk factors. Archives of Internal Medicine, 166, 1280–1287.CrossRefGoogle ScholarPubMed
Fitzgibbon, D.R. & Ready, L.B. (1997). Intravenous high-dose methadone administered by patient controlled analgesia and continuous infusion for the treatment of cancer pain refractory to high-dose morphine. Pain, 73, 259–261.CrossRefGoogle ScholarPubMed
Garson, A. (1993). How to measure the QT interval—What is normal. American Journal of Cardiology, 72, 14B–16B.CrossRefGoogle Scholar
Kornick, C.A., Kilborn, M.J., Santiago-Palma, J., et al. (2003). QTc interval prolongation associated with intravenous methadone. Pain, 105, 499–506.CrossRefGoogle ScholarPubMed
Krantz, M.J. & Mehler, P.S. (2006) QTc prolongation: Methadone's efficacy-safety paradox. Lancet, 368, 556–557.CrossRefGoogle ScholarPubMed
Lawlor, P.G., Turner, K.S., Hanson, J., et al. (1998). Dose ratio between morphine and methadone in patients with cancer pain: A retrospective study. Cancer, 82, 1167–1173.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Makin, M.K. (2000). Subcutaneous methadone in terminally-ill patients [letter]. Journal of Pain and Symptom Management, 19, 237–238.CrossRefGoogle ScholarPubMed
Manfredi, P.L., Borsook, D., Chandler, S.W., et al. (1997). Intravenous methadone for cancer pain unrelieved by morphine and hydromorphone: Clinical observations. Pain, 70, 99–101.CrossRefGoogle ScholarPubMed
Manfredi, P.L. & Houde, R.W. (2003). Prescribing methadone, a unique analgesic. Journal of Supportive Oncology, 1, 216–220.Google ScholarPubMed
Mathew, P. & Storey, P. (1999). Subcutaneous methadone in terminally ill patients: Manageable local toxicity. Journal of Pain and Symptom Management, 18, 49–52.CrossRefGoogle ScholarPubMed
Mercadante, S., Casuccio, A., & Calderone, L. (1999). Rapid switching from morphine to methadone in cancer patients with poor response to morphine. Journal of Clinical Oncology, 17, 1–6.CrossRefGoogle ScholarPubMed
Morley, J.S. & Makin, M.K. (1998). The use of methadone in cancer pain poorly responsive to other opioids. Pain Reviews, 5, 51–58.CrossRefGoogle Scholar
Moss, A.J., Zareba, W., Benhorin, J., et al. (2001). ISHNE guidelines for electrocardiographic evaluation of drug-related QT prolongation and other alterations in ventricular repolarization: Task force summary. A report of the Task Force of the International Society for Holter and Noninvasive Electrocardiology (ISHNE), Committee on Ventricular Repolarization. Annals of Noninvasive Electrocardiology, 6, 333–341.CrossRefGoogle ScholarPubMed
Payne, R. & Inturrisi, C.E. (1985). CSF distribution of morphine, methadone and sucrose after intrathecal injection. Life Sciences, 37, 1137–1144.CrossRefGoogle ScholarPubMed
Ripamonti, C., De Conno, F., Groff, L., et al. (1998). Equianalgesic dose/ratio between methadone and other opioid agonists in cancer pain: Comparison of two clinical experiences. Annals of Oncology, 9, 79–83.CrossRefGoogle ScholarPubMed
Roden, D.M. (2004). Drug-induced prolongation of the QT interval. New England Journal of Medicine, 350, 1013–1022.CrossRefGoogle ScholarPubMed
Santiago-Palma, J., Khojainova, N., Kornick, C., et al. (2001). Intravenous methadone in the management of chronic cancer pain: Safe and effective starting doses when substituting methadone for fentanyl. Cancer, 92, 1919–1925.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Sekine, R., Eugenia, A.M.T., Coyle, N., et al. (2007). The successful use of parenteral methadone in a patient with a prolonged QTc interval. Journal of Pain and Symptom Management, 34, 566–569.CrossRefGoogle Scholar
Shaiova, L. (2006). The role of methadone in the treatment of moderate to severe cancer pain. Supportive Cancer Therapy, 2, 1–5.Google Scholar