Switching from morphine to methadone to improve analgesia and tolerability in cancer patients

A prospective study

S. Mercadante, A. Casuccio, F. Fulfaro, L. Groff, R. Boffi, P. Villari, V. Gebbia, C. Ripamonti

Research output: Contribution to journalArticle

196 Citations (Scopus)

Abstract

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 opioid 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.

Original languageEnglish
Pages (from-to)2898-2904
Number of pages7
JournalJournal of Clinical Oncology
Volume19
Issue number11
Publication statusPublished - Jun 1 2001

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Methadone
Analgesia
Morphine
Prospective Studies
Pain
Neoplasms
Sleep Stages
Referred Pain
Constipation
Nausea
Opioid Analgesics
Vomiting

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Switching from morphine to methadone to improve analgesia and tolerability in cancer patients : A prospective study. / Mercadante, S.; Casuccio, A.; Fulfaro, F.; Groff, L.; Boffi, R.; Villari, P.; Gebbia, V.; Ripamonti, C.

In: Journal of Clinical Oncology, Vol. 19, No. 11, 01.06.2001, p. 2898-2904.

Research output: Contribution to journalArticle

Mercadante, S, Casuccio, A, Fulfaro, F, Groff, L, Boffi, R, Villari, P, Gebbia, V & Ripamonti, C 2001, 'Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: A prospective study', Journal of Clinical Oncology, vol. 19, no. 11, pp. 2898-2904.
Mercadante, S. ; Casuccio, A. ; Fulfaro, F. ; Groff, L. ; Boffi, R. ; Villari, P. ; Gebbia, V. ; Ripamonti, C. / Switching from morphine to methadone to improve analgesia and tolerability in cancer patients : A prospective study. In: Journal of Clinical Oncology. 2001 ; Vol. 19, No. 11. pp. 2898-2904.
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AU - Groff, L.

AU - Boffi, R.

AU - Villari, P.

AU - Gebbia, V.

AU - Ripamonti, C.

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N2 - 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 opioid 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.

AB - 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 opioid 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.

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