ORAL METHADONE IN CANCER PAIN – A CASE SERIES

Aswathi Praveen , Anuja Damani, Naveen Salins, Krithika Rao, Gayatri S

Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal,
Karnataka

Introduction Results
PATIENT CHARACTERISTICS PERCENTAGE
(%) METHADONE
Co-analgesic
AGE RANGE 37 – 66 years

GENDER
Male 60
Female 40
Molecular structure DIAGNOSIS
Head and neck cancer 40
Breast cancer 20 Primary
Mechanism of action ¹ analgesic
Advantages GI cancer 20
Lung cancer 10
• Useful in nociceptive and neuropathic pain. ² Cervical cancer 10
• Long acting opioid. Gaps TYPE OF PAIN TYPE OF PAIN
• Safe in renal impairment. ³ • No robust evidence Nociceptive+Neuropathic 40
for use as analgesic. Nociceptive+Myofascial 30 10
• Reduces tolerance to chronic opioid • No standard Nociceptive+Inflammatory 10
therapy. ⁴ conversion method. Nociceptive+Myofascial+Inflammatory 10
Nociceptive 10 5
OPIOID PRIOR TO CONVERSION
Morphine 70

Aim Tapentadol
Fentanyl
20
10
0

Review the cancer pain patients on oral methadone to assess its ADVERSE EVENTS
None 90
use as primary opioid analgesic, opioid rotation to methadone and
Sedation 10
co-analgesic. QT prolongation 0

Methods 10
PAIN ASSESSMENT

• Study type - Retrospective chart review 8

• Study settings - Inpatient and outpatient units of Department of 6

NRS

4
Palliative Medicine and Supportive Care, KMC, Manipal
2
• Time period - September 2022 to December 2022
0
• Sample size – 10 [6 - outpatients ; 4 - inpatients] 1 2 3 4 5 6 7 8 9 10
Patients
• Factors assessed - Site, intensity and type of pain, method of
Pre-switch pain score Post-switch pain score
starting methadone, baseline assessment before starting and
change in pain intensity, adverse effects, and potential drug OPIOID REQUIREMENT
interactions
160
Methadone was started as slower rotation (reduce and replace) 140
approach over 3 days.
OME/day (mg/day)

120
In this approach, the 24 hour methadone dose is first calculated 100
based on 24 hour oral morphine equivalent using Fisch method.⁵ 80
• Day 1 - 1/3rd primary opioid + 1/3rd of total target dose methadone 60

• Day 2 - Methadone increased to 2/3rd of the total target dose 40

• Day 3 - Primary opioid is discontinued and methadone increased 20

to 100% of the total target dose. 0

1 2 3 4 5 6 7 8 9 10
Patients
FISCH METHOD ⁵
Pre-switch OME/day (mg/day) Post-switch OME/day (mg/day)
ORAL MOPRHINE EQUIVALENT ORAL MORPHINE:ORAL METHADONE
(mg/day)
<30 2:1 Conclusion
30-99 4:1 Methadone is an excellent choice for opioid rotation in patients with
100-299 8:1 cancer pain as both primary analgesic and co-analgesic. However,
300-499 12:1 there is high variability in its use and opioid conversion methods.
500-999 15:1 Although effective, it requires individualized titration and careful
>1000 >20:1 monitoring.

References
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