The role of methadone in cancer pain treatment - a review
- 1 July 2009
- journal article
- review article
- Published by Hindawi Limited in International Journal of Clinical Practice
- Vol. 63 (7), 1095-1109
- https://doi.org/10.1111/j.1742-1241.2008.01990.x
Abstract
Methadone is an opioid analgesic of step 3 of the World Health Organization (WHO) analgesic ladder.To outline pharmacodynamics, pharmacokinetics, drug interactions, equianalgesic dose ratio with other opioids, dosing rules, adverse effects and methadone clinical studies in patients with cancer pain. A review of relevant literature on methadone use in cancer pain was conducted.Methadone is used in opioid rotation and administered to patients with cancer pain not responsive to morphine or other strong opioids when intractable opioid adverse effects appear. Methadone is considered as the first strong opioid analgesic and in patients with renal impairment. Methadone possesses different pharmacodynamics and pharmacokinetics in comparison to other opioids. The advantages of methadone include multimode analgesic activity, high oral and rectal bioavailability, long lasting analgesia, lack of active metabolites, excretion mainly with faeces, low cost and a weak immunosuppressive effect. The disadvantages include long and changeable plasma half-life, high bound to serum proteins, metabolism through P450 system, numerous drug interactions, lack of clear equianalgesic dose ratio to other opioids, QT interval prolongation, local reactions when administered subcutaneously.Methadone is an important opioid analgesic at step 3 of the WHO analgesic ladder. Future controlled studies may focus on establishment of methadone equianalgesic dose ratio with other opioids and its role as the first strong opioid in comparative studies with analgesia, adverse effects and quality of life taken into consideration.Keywords
This publication has 133 references indexed in Scilit:
- Switching from Methadone to a Different Opioid: What Is the Equianalgesic Dose Ratio?Journal of Palliative Medicine, 2008
- A Community-Based Evaluation of Sudden Death Associated with Therapeutic Levels of MethadoneAmerican Journal Of Medicine, 2008
- The Successful Use of Parenteral Methadone in a Patient with a Prolonged QTc IntervalJournal of Pain and Symptom Management, 2007
- Methadone-Induced Respiratory Depression After Discontinuing Carbamazepine AdministrationJournal of Pain and Symptom Management, 2006
- Methadone and Fluconazole: Respiratory Depression By Drug InteractionJournal of Pain and Symptom Management, 2002
- Methadone: Outpatient Titration and Monitoring Strategies in Cancer PatientsJournal of Pain and Symptom Management, 1999
- Subcutaneous Methadone in Terminally Ill Patients: Manageable Local ToxicityJournal of Pain and Symptom Management, 1999
- Transdermal fentanyl versussustained-release oral morphine in cancer pain: Preference, efficacy, and quality of lifeJournal of Pain and Symptom Management, 1997
- The d- and l- isomers of methadone bind to the non-competitive site on the N-methyl-d-aspartate (NMDA) receptor in rat forebrain and spinal cordNeuroscience Letters, 1997
- A randomized study on oral administration of morphine and methadone in the treatment of cancer painJournal of Pain and Symptom Management, 1986