Use of methadone in a highly tolerant patient receiving parenteral hydromorphone

Journal of Pain and Symptom Management
Z Thomas, E Bruera

Abstract

A 59-year-old woman with metastatic breast cancer experienced a poor response to increasing doses of hydromorphone, possibly related to the neuropathic nature of her pain. Ultimately, the cost of this treatment was more than $1000 per day. Administration of methadone, initially as an adjuvant and eventually as the sole analgesic, at a much smaller dose than expected resulted in very satisfactory analgesia, without the development of serious side effects. In addition, the cost of treatment decreased to less than $25 per day. This case illustrates the rationale and advantages for the use of methadone. Intraindividual variability in the response to various opioids is a factor to be considered when selecting analgesics. Methadone is a useful second-line or third-line opioid for the patient who is highly tolerant to other opioids, as it may demonstrate incomplete cross-tolerance with other agonist opioids. Switching of the opioid to methadone may be a worthwhile option to consider in managing patients who are highly tolerant to other opioids.

References

Aug 15, 1975·Life Sciences·A BaranD W Bailey
May 1, 1992·Journal of Pain and Symptom Management·E BrueraJ Hanson
Nov 1, 1991·European Heart Journal·J Abrams
Feb 1, 1993·Pain·R FainsingerE Bruera

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Citations

Feb 28, 2001·Journal of Pain and Symptom Management·S Mercadante, R K Portenoy
Mar 13, 2002·Journal of Pain and Symptom Management·Lauren ShaiovaE Daniela Hord
Oct 12, 1999·Journal of Pain and Symptom Management·S MercadanteL Barresi
Jan 1, 1997·European Journal of Pain : EJP·S Mercadante
Jul 11, 2000·Current Opinion in Oncology·I ManciniJ J Body
Jun 11, 1999·European Journal of Cancer Care·C F ScholesI F Trotman
Jun 21, 2008·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Douglas J Weschules, Kevin T Bain
Jul 17, 2004·British Journal of Clinical Pharmacology·Ola DaleEvan D Kharasch
Mar 11, 2004·Journal of Advanced Nursing·Margaret Wootton
Aug 13, 2002·Hematology/oncology Clinics of North America·Carla Ripamonti, Mauro Bianchi
Dec 1, 2011·Journal of Pain & Palliative Care Pharmacotherapy·Virginia LeBaronLinda Snyder
Jan 1, 2004·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Eduardo BrueraMichael J Fisch
Jan 15, 2004·Anesthesiology Clinics of North America·Paul J Christo
Oct 22, 2013·The Cochrane Database of Systematic Reviews·Columba Quigley
May 2, 2001·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·N ChernyUNKNOWN Expert Working Group of the European Association of Palliative Care Network

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