Dose ratio between morphine and methadone in patients with cancer pain - A retrospective study
Dose ratio between morphine and methadone in patients with cancer pain - A retrospective study
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DOI：
10.1002/(sici)1097-0142(19980315)82:6
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发表时间：
1998-03-15
期刊：
影响因子：
6.2
通讯作者：
Bruera, ED
中科院分区：
文献类型：
--
作者：
Lawlor, PG;Turner, KS;Bruera, ED
背景目前的等效镇痛参考表主要基于单剂量研究，口服吗啡与口服美沙酮的剂量比为1：1至4：1，这在暴露于多剂量这些阿片类药物的癌症疼痛患者中可能不准确。本研究的目的是确定癌症疼痛患者吗啡和美沙酮之间的等效镇痛剂量比，并确定剂量比是否随既往阿片类药物剂量而变化。使用标准选择标准对涉及吗啡和美沙酮的连续轮换进行回顾性分析，共确定了20个可评价的轮换（14个从吗啡到美沙酮，6个从美沙酮到吗啡）。阿片类药物剂量和疼痛强度水平前和后旋转进行了分析。吗啡与美沙酮和美沙酮与吗啡轮换的中位剂量比（下-上四分位数）分别为11.36（范围，5.98-16.27）和8.25（范围，4.37-11.3）（P = 0.23）。结合所有20次旋转，计算出统一的中位剂量比为11.2（范围，5.06-13.24）。在视觉模拟量表上记录的旋转前和旋转后的疼痛强度水平无显著差异。剂量比和轮换前每日吗啡剂量水平的单变量相关分析显示斯皮尔曼相关系数为0.86（P = 0.0001）。在美沙酮轮换前接受>1165 mg/天的患者中，观察到的中位剂量比为16.81（范围，12.25-87.95），与接受较低吗啡剂量的50%患者的中位剂量比5.42（范围，2.95-9.09）相比，约高3倍（P = 0.007）。结果强调了美沙酮效力的普遍低估以及由此产生的潜在危及生命毒性的风险。剂量比与先前吗啡剂量之间的强正相关性表明，在患者从吗啡转向美沙酮时需要采取高度个性化和谨慎的方法。癌症疼痛。(C)1998年美国癌症协会。
BACKGROUND. Current equianalgesic reference tables, based largely on single dose studies, give dose ratios of 1:1 to 4:1 for oral morphine to oral methadone, which possibly are inaccurate in patients with cancer pain who are exposed to multiple doses of these opioids. The purpose of this study was to determine the equianalgesic dose ratio between morphine and methadone in patients with cancer pain and to establish whether the dose ratio changes as a function of previous opioid dose.METHODS. A retrospective analysis of consecutive rotations involving morphine and methadone using standard selection criteria identified a total of 20 evaluable rotations (14 from morphine to methadone and 6 from methadone to morphine). Opioid doses and pain intensity levels pre-and postrotation were analyzed.RESULTS. Median dose ratios (lower-upper quartiles) for morphine to methadone and methadone to morphine rotations were 11.36 (range, 5.98-16.27) and 8.25 (range, 4.37-11.3), respectively (P = 0.23). Combining all 20 rotations, a unified median dose ratio of 11.2 (range, 5.06-13.24) was calculated. There was no significant difference in pain intensity levels pre-and postrotation as recorded on a visual analogue scale. Univariate correlational analysis of dose ratio and the level of daily morphine dose prior to rotation revealed a Spearman correlation coefficient of 0.86 (P = 0.0001). In patients receiving >1165 mg per day prior to methadone rotation, a median dose ratio of 16.81 (range, 12.25-87.95) was observed, which was approximately 3 times higher compared with a median dose ratio of 5.42 (range, 2.95-9.09) (P = 0.007) for the 50% of patients receiving lower morphine doses.CONCLUSIONS. The results highlight the general underestimation of methadone potency and the consequent risk of potential life-threatening toxicity, The strongly positive correlation between dose ratio and previous morphine dose suggests the need for a highly individualized and cautious approach when rotating from morphine to methadone in patients with cancer pain. (C) 1998 American Cancer Society.