USE OF METHADONE IN A HIGHLY TOLERANT PATIENT RECEIVING PARENTERAL HYDROMORPHONE

A 59-year-old woman with metastatic breast cancer experienced a poor r esponse 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 a s an adjuvant and eventually as the sole analgesic, at a much smaller dose than expected resulted in very satisfactory analgesia, without th e development of serious side effects. In addition, the cost of treatm ent decreased to less than $25 per day. This case illustrates the rati onale and advantages for the use of methadone. Intraindividual variabi lity in the response to various opioids is a factor to be considered w hen selecting analgesics. Methadone is a useful second-line or third-l ine opioid for the patient who is highly tolerant to other opioids, as it may demonstrate incomplete cross-tolerance with other agonist opio ids. Switching of the opioid to methadone may be a worthwhile option t o consider in managing patients who are highly tolerant to other opioi ds.