Methadone: Outpatient titration and monitoring strategies in cancer patients

Methadone can be an effective drug for cancer pain but if can also be diffi cult to use safely. A has been recommended that rotation to methadone from other opioids be undertaken in a hospital setting. The purpose of the study was to characterize the safety, toxicities, and outcomes of outpatient rot ation to methadone for severe cancer pain in a heavily pretreated cohort of cancer patients. Data were collected through a retrospective review of con secutive patients from a tertiary level cancer pain clinic. Twenty-nine pat ients were rotated to methadone 13 (45%) due to opioid toxicity and 16 (55% ) because of either cost ol difficulty swallowing their prior opioid. Eleve n of 29 patients (38%) failed methadone dele to rapidly progressive cancer dose-limiting side effects, or other reasons, bat the other patients were s uccessfully rotated to methadone. Pain usually improved following rotation to methadone but drowsiness from methadone was common. On average, it took 32 days to successfully rotate to methadone in the outpatient setting. Canc er patients with advanced disease and severe pain can be safely and effecti vely rotated to methadone in the outpatient setting. It takes considerably longer to stabilize these patients than patients on lower doses of opioid o r those titrated in the inpatient setting: A careful monitoring system is n eeded to screen for evidence of toxicity. J Pain Symptom Manage 1999;18:369 -375. (C) U.S. Cancer Pain Relief Committee 1999.