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Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain.
Cancer. 2004 Dec 15; 101(12):2866-73.C

Abstract

BACKGROUND

Patients with cancer often are rotated from other opioids to methadone to improve the balance between analgesia and side effects. To the authors' knowledge, no clear guidelines currently exist for the safe and effective rotation from transdermal fentanyl to methadone.

METHODS

The authors evaluated a protocol for switching opioid from transdermal fentanyl to oral methadone in 17 patients with cancer. Reasons for switching were uncontrolled pain (41.1% of patients) and neurotoxic side effects (58.9% of patients). Methadone was initiated 8-24 hours after fentanyl withdrawal, depending on the patient's previous opioid doses (from < 100 microg per hour to > 300 microg per hour). The starting methadone dose was calculated according to a 2-step conversion between transdermal fentanyl:oral morphine (1:100 ratio) and oral morphine:oral methadone (5:1 ratio or 10:1 ratio). The correlation between previous fentanyl dose and the final methadone dose or the fentanyl:methadone dose ratio was assessed by means of Pearson and Spearman correlation coefficients (r), respectively. A Friedman test was used to compare pain intensity before and after the switch and the use of daily rescue doses.

RESULTS

Opioid rotation was fully or partially effective in 80% and 20%, respectively, of patients with somatic pain. Neuropathic pain was not affected by opioid switching. Delirium and myoclonus were reverted in 80% and 100% of patients, respectively, after opioid switching. A positive linear correlation was obtained between the fentanyl and methadone doses (Pearson r, 0.851). Previous fentanyl doses were not correlated with the final fentanyl:methadone dose ratios (Spearman r, - 0.327).

CONCLUSIONS

The protocol studied provided a safe approach for switching from transdermal fentanyl to oral methadone, improving the balance between analgesia and side effects in patients with cancer.

Authors+Show Affiliations

Benítez-Rosario MA
Palliative Care Unit and Research Unit, Hospital La Candelaria, Canary Health Service, Tenerife, Spain. mabenitez@comtf@es
Feria M
No affiliation info available
Salinas-Martín A
No affiliation info available
Martínez-Castillo LP
No affiliation info available
Martín-Ortega JJ
No affiliation info available

MeSH

Administration, CutaneousAdministration, OralAdultAgedAnalgesics, OpioidDrug Administration ScheduleFemaleFentanylHumansMaleMethadoneMiddle AgedNeoplasmsPain MeasurementPain, IntractablePalliative CareTime Factors

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

15529307

Citation

Benítez-Rosario, Miguel Angel, et al. "Opioid Switching From Transdermal Fentanyl to Oral Methadone in Patients With Cancer Pain." Cancer, vol. 101, no. 12, 2004, pp. 2866-73.
Benítez-Rosario MA, Feria M, Salinas-Martín A, et al. Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. Cancer. 2004;101(12):2866-73.
Benítez-Rosario, M. A., Feria, M., Salinas-Martín, A., Martínez-Castillo, L. P., & Martín-Ortega, J. J. (2004). Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. Cancer, 101(12), 2866-73.
Benítez-Rosario MA, et al. Opioid Switching From Transdermal Fentanyl to Oral Methadone in Patients With Cancer Pain. Cancer. 2004 Dec 15;101(12):2866-73. PubMed PMID: 15529307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid switching from transdermal fentanyl to oral methadone in patients with cancer pain. AU - Benítez-Rosario,Miguel Angel, AU - Feria,Manuel, AU - Salinas-Martín,Antonio, AU - Martínez-Castillo,Luis Pedro, AU - Martín-Ortega,José Javier, PY - 2004/11/6/pubmed PY - 2004/12/31/medline PY - 2004/11/6/entrez SP - 2866 EP - 73 JF - Cancer JO - Cancer VL - 101 IS - 12 N2 - BACKGROUND: Patients with cancer often are rotated from other opioids to methadone to improve the balance between analgesia and side effects. To the authors' knowledge, no clear guidelines currently exist for the safe and effective rotation from transdermal fentanyl to methadone. METHODS: The authors evaluated a protocol for switching opioid from transdermal fentanyl to oral methadone in 17 patients with cancer. Reasons for switching were uncontrolled pain (41.1% of patients) and neurotoxic side effects (58.9% of patients). Methadone was initiated 8-24 hours after fentanyl withdrawal, depending on the patient's previous opioid doses (from < 100 microg per hour to > 300 microg per hour). The starting methadone dose was calculated according to a 2-step conversion between transdermal fentanyl:oral morphine (1:100 ratio) and oral morphine:oral methadone (5:1 ratio or 10:1 ratio). The correlation between previous fentanyl dose and the final methadone dose or the fentanyl:methadone dose ratio was assessed by means of Pearson and Spearman correlation coefficients (r), respectively. A Friedman test was used to compare pain intensity before and after the switch and the use of daily rescue doses. RESULTS: Opioid rotation was fully or partially effective in 80% and 20%, respectively, of patients with somatic pain. Neuropathic pain was not affected by opioid switching. Delirium and myoclonus were reverted in 80% and 100% of patients, respectively, after opioid switching. A positive linear correlation was obtained between the fentanyl and methadone doses (Pearson r, 0.851). Previous fentanyl doses were not correlated with the final fentanyl:methadone dose ratios (Spearman r, - 0.327). CONCLUSIONS: The protocol studied provided a safe approach for switching from transdermal fentanyl to oral methadone, improving the balance between analgesia and side effects in patients with cancer. SN - 0008-543X UR - https://www.unboundmedicine.com/medline/citation/15529307/Opioid_switching_from_transdermal_fentanyl_to_oral_methadone_in_patients_with_cancer_pain_ DB - PRIME DP - Unbound Medicine ER -