Switching From Morphine to Methadone to Improve Analgesia and Tolerability in Cancer Patients: A Prospective Study

Sebastiano Mercadante, Alessandra Casuccio, Fabio Fulfaro, Liliana Groff, Roberto Boffi, Patrizia Villari, Vittorio Gebbia, Carla Ripamonti
2001 Journal of Clinical Oncology  
S w i t c h i n g F r o m M o r p h i n e t o M e t h a d o n e t o I m p r o v e A n a l g e s i a a n d T o l e r a b i l i t y i n C a n c e r P a t i e n t s : A P r o s p e c t i v e S t u d y Purpose: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. Patients and Methods: Fifty-two consecutive cancer patients receiving oral morphine but with uncontrolled pain and/or moderate to severe
more » ... pioid adverse effects were switched to oral methadone administered every 8 hours using different dose ratios. Intensity of pain and adverse effects were assessed daily, and the symptom distress score (DS) was calculated before and after switching. Results: Data were analyzed for 50 patients. Switching was considered effective in 80% of the patients; results were achieved in an average of 3.65 days. In the 10 patients who switched to methadone because of uncontrolled pain, a significant reduction in pain intensity (P < .005) and an average of a 33% increase in methadone doses necessary (P < .01) were found after an average of 3.5 days. DS significantly decreased from an average of 8.4 to 4.5 (P < .0005). In the 32 patients switching because of uncontrolled pain and morphine-related adverse effects, significant improvement was found in pain intensity (P < .0005), nausea and vomiting (P < .03), constipation (P < .001), and drowsiness (P < .01), but a significant increase in the methadone dose of an average of 20% (P < .004) was required. Conclusion: In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option. In the clinical setting of poor pain control, higher doses of methadone are necessary with respect to the equianalgesic calculated dose ratios previously published.
doi:10.1200/jco.2001.19.11.2898 pmid:11387363 fatcat:smoklqbbv5e6bh3hhejzomhdfe