TITLE

An ad libitum schedule for conversion of morphine to methadone in advanced cancer patients: an open uncontrolled prospective study in a Chinese population

AUTHOR(S)
Tse, Doris MW; Sham, Michael MK; Ng, Daniel KH; Ma, HM
PUB. DATE
March 2003
SOURCE
Palliative Medicine;Mar2003, Vol. 17 Issue 2, p206
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Methadone has been used as an alternative strong opioid to morphine in the management of cancer pain. The conversion of morphine to methadone is not straightforward because of the high individual variability and unpredictability in the pharmacokinetics of methadone. An ad libitum schedule for conversion of morphine to methadone was used in 37 cancer patients who had intolerable morphine-related side effects or had pain not satisfactorily controlled by morphine. Oral morphine was discontinued on the day of conversion. Methadone was given at a dose calculated as one-twelfth of the total daily dose of morphine, up to a maximum of 30 mg/dose. Methadone was administered at patient-controlled intervals not more frequent than three hours, the need of which was indicated by the presence of pain of moderate intensity or above as rated by a verbal rating scale. When the demand for methadone was stabilized, the total daily dose was given regularly in divided doses. Pain control on day 7 was taken as the primary endpoint. Twentyseven patients completed the study. Twenty-four patients (88.9%) were in good pain control on day 7, and all reached good pain control by day 11. The median time required to achieve good pain control was three days (range 1-11 days). A majority (88.6%) of morphine-related adverse effects improved or resolved after conversion to methadone. This ad libitum schedule is effective in conversion of morphine to methadone in these patients.
ACCESSION #
9377508

 

Related Articles

  • Morphine: The benefits are worth the risks. Brown, Susan J. // RN;Mar87, Vol. 50 Issue 3, p20 

    Presents guidelines on the use of morphine to control pain in cancer patients. Mechanism of action of morphine; Manner by which morphine can be administered effectively; Effect of delays in administration. INSET: My wish for Willie.

  • Recent Literature. Rousseau, Paul C. // Journal of Palliative Medicine;Fall1998, Vol. 1 Issue 3, p301 

    Presents an abstract of the study 'Controlled-Release Morphine Tablets in Patients With Chronic Cancer Pain. A Narrative Review of Controlled Clinical Trials,' by C. Warfield, which appeared in the 1998 issue of Cancer.

  • The role of morphine glucuronides in cancer pain. Mercadante, S. // Palliative Medicine;1999, Vol. 13 Issue 2, p95 

    Morphine metabolites are involved in various ways in determining the complex effects of morphine, both favourable and adverse, and may complicate the clinical use of morphine in the treatment of cancer pain. The production and effects of the principal morphine metabolites, morphine-3-glucuronide...

  • A Patient Preference Study Comparing Two Extended-Release Morphine Sulfate Formulations (Once-Daily Kadian versus Twice-Daily MS Contin) for Cancer Pain. Kerr, R.O.; Tester, W.J. // Clinical Drug Investigation;2000, Vol. 19 Issue 1, p25 

    Objective: To compare pain control, patient preference and tolerability for two extended-release formulations of morphine sulfate, Kadian capsules (administered once daily) and MS Contin tablets (administered twice daily), in the treatment of chronic cancer pain. Patients and Methods: A...

  • Morphine, constipation and performance status in advanced cancer patients. Fallon, M.T. // Palliative Medicine;1999, Vol. 13 Issue 2, p159 

    Studies constipation associated with the use of morphine in treatment of pain caused by advanced cancer. Characteristics of cancer patients included in the study; Conflict between data from the study and beliefs about morphine-caused constipation.

  • Intravenous morphine for rapid control of severe cancer pain. Harris, J T; Suresh Kumar, K; Rajagopal, M R // Palliative Medicine;Apr2003, Vol. 17 Issue 3, p248 

    This randomized controlled trial compared intravenous route with oral route for initial dose titration of morphine in 62 patients with end-stage cancer and severe pain. Patients in the intravenous group received 1.5 mg intravenous bolus doses of morphine every ten minutes till pain relief was...

  • The effects of oral morphine in "titration phase" of carcinoma pain treatment. Ljuca, Dzenita; Husic, Samir // HealthMed;Jun2010, Vol. 4 Issue 2, p434 

    The aim of the research was to establish the optimal dosage of oral morphine which would be adequate for pain control, its negative effects, frequency, intensity and the occurrence of breakthrough pain (BTP) in titration phase of severe carcinoma pain. Patients and methods. A prospective study...

  • Intravenous morphine for emergency treatment of cancer pain. Suresh Kumar, K.; Rajagopal, M.; Naseema, A. // Palliative Medicine;May2000, Vol. 14 Issue 3, p183 

    Despite the wide use of the World Health Organization (WHO) analgesic ladder for the relief of cancer pain, it is not uncommon to find patients presenting with severe pain to palliative care centres. This is more so in the developing world, where facilities for pain relief are few and the health...

  • The MERITO Study: a multicentre trial of the analgesic effect and tolerability of normal-release oral morphine during 'titration phase' in patients with cancer pain. de Conno, F.; Ripamonti, C.; Fagnoni, E.; Brunelli, C.; Luzzani, M.; Maltoni, M.; Arcuri, E.; Bertetto, O. // Palliative Medicine;Apr2008, Vol. 22 Issue 3, p214 

    Adequate and rapid pain control is one of the main goals of cancer pain treatment. The objective of this study was to assess the effect and tolerability of oral normal-release morphine during the initial phase of treatment in patients with moderate-to-severe cancer pain. Consecutive patients...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics