Methadone “ Simply Rotate” Study. Ahmed Elsayem, MD Associate professor Director of PCU Dept of PC & Rehabilitation Med. Cancer Pain. Most feared complication of cancer < 50% obtain optimal pain control
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Ahmed Elsayem, MD
Director of PCU
Dept of PC & Rehabilitation Med.
- Myoclonus/ seizures
Quigley C. Opioid switching. Cochrane Database Syst Rev 2004.
Mercadante et al. JCO 1998
Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F.
Switching from morphine to oral methadone in treating cancer pain: what is the equianalgesic dose ratio?
Journal of Clinical Oncology. 1998;16(10):3216-21.
- Inducers ↑ clearance = pain
Antiviral drugs (ritonavir)
Acute alcohol ingestion
Anticonvulsants (phenobarbital, phenytoin)
To compare the effectiveness (i.e. nalgesia) of an opioid rotation to oral methadone vs opioid rotation to another long-acting strong opioid (sustained-release morphine
*Divide the calculated oral MEDD by this number to get the initial methadone dose
Patient is prescribed sustained-release morphine 60mg every 12 hours and immediate-release morphine 15 mg every 3 hours as needed for breakthrough pain.
Patient is reportedly taking 8 doses of immediate-release morphine per day with little relief (pain is rated as a 9/10).
What is the starting methadone dose?
- Dr. Michael Fisch, - Dr. Ahmed Elsayem, - Dr. Nada Fadulthrough the M. D. Anderson page operator (713 792 7090)