Tags

Type your tag names separated by a space and hit enter

Morphine-methadone opioid rotation in cancer patients: analysis of dose ratio predicting factors.
J Pain Symptom Manage. 2009 Jun; 37(6):1061-8.JP

Abstract

The dose ratio that is effective when switching opioid therapy from morphine to methadone in cancer patients varies widely. There are no conclusive data explaining the source of this variability. We analyzed 54 cancer patients undergoing opioid rotation to clarify those factors that influenced the morphine/methadone dose ratio (MMEDR) at Day 10 after the switch. Reasons for switching were uncontrolled pain (10 patients) or side effects (with or without pain, 44 patients). Initial MMEDR was 5:1 or 10:1 (82% or 18% of patients, respectively). Multivariate regression analysis was used to identify the demographic, cancer-related, and treatment-related variables that were potential predictors of MMEDR. Median previous morphine dose for the entire sample was 220 mg/day (range: 30-1000 mg/day). The stable MMEDR median was 5:1 (range: 2:1-15:1). In the univariate analysis, reasons for opioid rotation, age, and previous morphine doses were associated with MMEDR. Multiple linear regression analysis showed that only the reason for switching (pain vs. side effects; P<0.001) and previous morphine doses (lower vs. upper to 300 mg/day; P<0.001) were associated with MMEDR. From this analysis, the MMEDRs for patients rotated for side effects at 300 mg/day or more or less than 300 mg/day of morphine were 9.1:1 or 5.6:1, respectively, and the MMEDRs for those switched for pain at 300 mg/day or more or less than 300 mg/day of morphine were 4.9:1 or 3:1, respectively. Both the reasons for opioid rotation and previous morphine doses are predictive factors and should be used to select the MMEDR more accurately.

Authors+Show Affiliations

Palliative Care Unit, NS Candelaria University Hospital, Canary Health Service, Department of Pharmacology, University of La Laguna, 38271 La Laguna, Tenerife, Spain. mabenros@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19171458

Citation

Benítez-Rosario, Miguel Angel, et al. "Morphine-methadone Opioid Rotation in Cancer Patients: Analysis of Dose Ratio Predicting Factors." Journal of Pain and Symptom Management, vol. 37, no. 6, 2009, pp. 1061-8.
Benítez-Rosario MA, Salinas-Martín A, Aguirre-Jaime A, et al. Morphine-methadone opioid rotation in cancer patients: analysis of dose ratio predicting factors. J Pain Symptom Manage. 2009;37(6):1061-8.
Benítez-Rosario, M. A., Salinas-Martín, A., Aguirre-Jaime, A., Pérez-Méndez, L., & Feria, M. (2009). Morphine-methadone opioid rotation in cancer patients: analysis of dose ratio predicting factors. Journal of Pain and Symptom Management, 37(6), 1061-8. https://doi.org/10.1016/j.jpainsymman.2008.05.016
Benítez-Rosario MA, et al. Morphine-methadone Opioid Rotation in Cancer Patients: Analysis of Dose Ratio Predicting Factors. J Pain Symptom Manage. 2009;37(6):1061-8. PubMed PMID: 19171458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Morphine-methadone opioid rotation in cancer patients: analysis of dose ratio predicting factors. AU - Benítez-Rosario,Miguel Angel, AU - Salinas-Martín,Antonio, AU - Aguirre-Jaime,Armando, AU - Pérez-Méndez,Lina, AU - Feria,Manuel, Y1 - 2009/01/25/ PY - 2008/04/01/received PY - 2008/05/13/revised PY - 2008/06/16/accepted PY - 2009/1/28/entrez PY - 2009/1/28/pubmed PY - 2009/8/20/medline SP - 1061 EP - 8 JF - Journal of pain and symptom management JO - J Pain Symptom Manage VL - 37 IS - 6 N2 - The dose ratio that is effective when switching opioid therapy from morphine to methadone in cancer patients varies widely. There are no conclusive data explaining the source of this variability. We analyzed 54 cancer patients undergoing opioid rotation to clarify those factors that influenced the morphine/methadone dose ratio (MMEDR) at Day 10 after the switch. Reasons for switching were uncontrolled pain (10 patients) or side effects (with or without pain, 44 patients). Initial MMEDR was 5:1 or 10:1 (82% or 18% of patients, respectively). Multivariate regression analysis was used to identify the demographic, cancer-related, and treatment-related variables that were potential predictors of MMEDR. Median previous morphine dose for the entire sample was 220 mg/day (range: 30-1000 mg/day). The stable MMEDR median was 5:1 (range: 2:1-15:1). In the univariate analysis, reasons for opioid rotation, age, and previous morphine doses were associated with MMEDR. Multiple linear regression analysis showed that only the reason for switching (pain vs. side effects; P<0.001) and previous morphine doses (lower vs. upper to 300 mg/day; P<0.001) were associated with MMEDR. From this analysis, the MMEDRs for patients rotated for side effects at 300 mg/day or more or less than 300 mg/day of morphine were 9.1:1 or 5.6:1, respectively, and the MMEDRs for those switched for pain at 300 mg/day or more or less than 300 mg/day of morphine were 4.9:1 or 3:1, respectively. Both the reasons for opioid rotation and previous morphine doses are predictive factors and should be used to select the MMEDR more accurately. SN - 1873-6513 UR - https://www.unboundmedicine.com/medline/citation/19171458/Morphine_methadone_opioid_rotation_in_cancer_patients:_analysis_of_dose_ratio_predicting_factors_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(08)00653-2 DB - PRIME DP - Unbound Medicine ER -