Switching from Methadone to a Different Opioid: What Is the Equianalgesic Dose Ratio?
Switching from Methadone to a Different Opioid: What Is the Equianalgesic Dose Ratio?
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DOI：
10.1089/jpm.2007.0285
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发表时间：
2008-10-01
影响因子：
2.8
通讯作者：
Bruera, Eduardo
中科院分区：
文献类型：
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作者：
Walker, Paul W.;Palla, Shana;Bruera, Eduardo
美沙酮（ME）是一种用于难治性疼痛综合征的高效阿片受体激动剂。然而，在使用强效阿片类药物治疗癌症疼痛时，由于副作用或疼痛控制不良，可能需要轮换使用不同的阿片类药物（阿片类药物轮换）。从美沙酮到另一种阿片类药物的轮换已经收到了有限的研究，因此可能是困难的，因为没有一个统一接受的剂量转换ratio.Methods：回顾性审查连续的病历进行阿片类药物轮换美沙酮替代阿片类药物的患者进行了评价。对于入选，要求患者接受美沙酮治疗至少3天，并在随后7天内达到替代阿片类药物的稳定剂量。稳定剂量定义为阿片类药物剂量从一天到下一天的变化不超过30%。从分析中排除了5例在7天内重新开始接受美沙酮治疗的患者，2例不规则使用阿片类药物导致转换后的常规阿片类药物剂量可忽略不计，3例由于担心芬太尼使用多种途径的可靠性。29例患者（10例女性，平均年龄48 ± 14.4岁）的数据可评价。口服美沙酮与口服吗啡等效日剂量（MEDD）的平均剂量比为1：4.7（95%置信区间[CI]，3.0-6.5; n = 16），静脉注射（IV）美沙酮与MEDD的平均剂量比为1：13.5（95% CI，6.6-20.5; n = 13），p = 0.06。美沙酮剂量与美沙酮IV和口服转换阿片类药物后的稳定MEDD显著相关（分别为斯皮尔曼= 0.86，p = 0.0001和斯皮尔曼= 0.72，p = 0.0024）。达到稳定剂量的平均日为第2.5天+/- 0.2静脉美沙酮和第2.6天+/- 0.3口服methadone.Conclusion：这些剂量比是新的发现，可能有助于患者更安全地切换到替代阿片类药物时，发生副作用或疼痛问题时，患者接受美沙酮。静脉注射和口服ME之间的镇痛效力似乎存在重要差异。需要进一步进行前瞻性研究。
Introduction: Methadone (ME) is a highly effective opioid agonist used for difficult pain syndromes. However, in the management of cancer pain with strong opioids, rotation to a different opioid (opioid rotation) may be required because of side effects or poor pain control. Rotation from methadone to another opioid has received limited study and therefore may be difficult because of the absence of a uniformly accepted dose conversion ratio.Methods: Retrospectively reviewed consecutive medical records of patients undergoing an opioid rotation from methadone to an alternative opioid were evaluated. For inclusion, patients were required to have received methadone for at least 3 days and have reached stable dose of the alternative opioid(s) during the 7 days following. Stable dose was defined as a 30% or less change in opioid dose from one day to the next.Results: Records of 39 patients met inclusion criteria. Excluded from analysis were 5 patients who were restarted on methadone within 7 days, 2 with irregular opioid use resulting in negligible regular opioid doses post-switch, and 3 due to concerns about reliability of multiple routes used for fentanyl. Data from 29 patients, 10 female, mean age 48 +/- 14.4 years, were evaluable. The mean dose ratio for oral methadone to oral morphine equivalent daily dose (MEDD) was 1:4.7 (95% confidence interval [CI], 3.0-6.5; n = 16), and for intravenous (IV) methadone to MEDD was 1:13.5 (95% CI, 6.6-20.5; n = 13), p = 0.06. Methadone dose was significantly correlated to stable MEDD after switching opioids for both methadone IV and oral (Spearman = 0.86, p = 0.0001 and Spearman = 0.72, p = 0.0024), respectively. Mean day of achieving stable dose was day 2.5 +/- 0.2 for IV methadone and day 2.6 +/- 0.3 for oral methadone.Conclusion: These dose ratios are new findings that may assist in switching patients more safely to alternative opioids when side effects or pain problems occur when patients are receiving methadone. An important difference in analgesic potency appears to exist between IV and oral ME. Future research with prospective studies is required.