dc.creatorMammana, Guillermo
dc.creatorBertolino, Mariela
dc.creatorBruera, Eduardo Pedro
dc.creatorOrellana, Fernando
dc.creatorVega, Fanny
dc.creatorPeirano, María Gabriela
dc.creatorBunge, Sofia
dc.creatorArmesto, Arnaldo Raúl
dc.creatorDran, Graciela Isabel
dc.date.accessioned2022-08-18T15:12:00Z
dc.date.accessioned2022-10-15T03:03:56Z
dc.date.available2022-08-18T15:12:00Z
dc.date.available2022-10-15T03:03:56Z
dc.date.created2022-08-18T15:12:00Z
dc.date.issued2021-04
dc.identifierMammana, Guillermo; Bertolino, Mariela; Bruera, Eduardo Pedro; Orellana, Fernando; Vega, Fanny; et al.; First-line methadone for cancer pain: titration time analysis; Springer; Supportive Care In Cancer; 29; 11; 4-2021; 6335-6341
dc.identifier0941-4355
dc.identifierhttp://hdl.handle.net/11336/166001
dc.identifierCONICET Digital
dc.identifierCONICET
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/4338017
dc.description.abstractBackground: Methadone is a low-cost, strong opioid that is increasingly used as a first-line treatment for pain in palliative care (PC). Its long and unpredictable half-life and slow elimination phase can make titration challenging. Evidence for titration modalities is scarce. Objective: To describe the titration phase of the treatment with low-dose first-line methadone and the use of methadone for breakthrough pain. Methods: Prospective study with strong opioid–naïve patients with moderate to severe cancer pain followed at a tertiary PC unit in Argentina. Starting methadone dose was 2.5–5 mg/day every 8, 12, or 24 h. Titration allowed daily dose increases from day 1, and prescription of oral methadone 2.5 mg every 2 h with a maximum of 3 rescue doses/day for breakthrough pain. Pain control, methadone stabilization dose, and adverse effects, among other variables, were daily assessed over the first 7 days (T0–T7). Results: Sixty-two patients were included. Initial median (IQR) methadone dose was 5 (2.5) mg/day. Pain intensity decreased from a median (IQR) of 8 (2.3) at T0 to 4 (2.3) at T1 and remained ≤ 4 until T7 (all p < 0.0001 compared to T0). Similar results were obtained through the categorical and tolerability scales for pain. Fifty patients (81%) reached pain control, 66% in the first 48 h. Methadone daily doses at T2 and T7 were higher than that at T0: 7.5 (3) and 6.7 (5.5) versus 5 (2.5), respectively (all p < 0.05). The opioid escalation index at T7 was 1.7%. The median (IQR) number of rescues, stabilization dose, and time for stabilization was 0 (1), 5(4.5) mg, and 3(2) days, respectively. Two patients were discontinued due to delirium. All other side effects were mild. Conclusions: First-line, low-dose methadone using rescue methadone resulted in a pronounced and rapid decrease in pain, with minimal need for titration and for breakthrough doses, and no evidence of accumulation or sedation by the end of the week.
dc.languageeng
dc.publisherSpringer
dc.relationinfo:eu-repo/semantics/altIdentifier/url/https://link.springer.com/10.1007/s00520-021-06211-y
dc.relationinfo:eu-repo/semantics/altIdentifier/doi/https://doi.org/10.1007/s00520-021-06211-y
dc.rightshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectADVANCED CANCER
dc.subjectCANCER PAIN
dc.subjectFIRST-LINE METHADONE
dc.subjectTITRATION
dc.titleFirst-line methadone for cancer pain: titration time analysis
dc.typeinfo:eu-repo/semantics/article
dc.typeinfo:ar-repo/semantics/artículo
dc.typeinfo:eu-repo/semantics/publishedVersion


Este ítem pertenece a la siguiente institución