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dc.contributor.author
Mammana, Guillermo
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Bertolino, Mariela
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Bruera, Eduardo Pedro
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Orellana, Fernando
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Vega, Fanny
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Peirano, María Gabriela
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Bunge, Sofia
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Armesto, Arnaldo Raúl
dc.contributor.author
Dran, Graciela Isabel
dc.date.available
2022-08-18T15:12:00Z
dc.date.issued
2021-04
dc.identifier.citation
Mammana, Guillermo; Bertolino, Mariela; Bruera, Eduardo Pedro; Orellana, Fernando; Vega, Fanny; et al.; First-line methadone for cancer pain: titration time analysis; Springer; Supportive Care In Cancer; 29; 11; 4-2021; 6335-6341
dc.identifier.issn
0941-4355
dc.identifier.uri
http://hdl.handle.net/11336/166001
dc.description.abstract
Background: Methadone is a low-cost, strong opioid that is increasingly used as a first-line treatment for pain in palliative care (PC). Its long and unpredictable half-life and slow elimination phase can make titration challenging. Evidence for titration modalities is scarce. Objective: To describe the titration phase of the treatment with low-dose first-line methadone and the use of methadone for breakthrough pain. Methods: Prospective study with strong opioid–naïve patients with moderate to severe cancer pain followed at a tertiary PC unit in Argentina. Starting methadone dose was 2.5–5 mg/day every 8, 12, or 24 h. Titration allowed daily dose increases from day 1, and prescription of oral methadone 2.5 mg every 2 h with a maximum of 3 rescue doses/day for breakthrough pain. Pain control, methadone stabilization dose, and adverse effects, among other variables, were daily assessed over the first 7 days (T0–T7). Results: Sixty-two patients were included. Initial median (IQR) methadone dose was 5 (2.5) mg/day. Pain intensity decreased from a median (IQR) of 8 (2.3) at T0 to 4 (2.3) at T1 and remained ≤ 4 until T7 (all p < 0.0001 compared to T0). Similar results were obtained through the categorical and tolerability scales for pain. Fifty patients (81%) reached pain control, 66% in the first 48 h. Methadone daily doses at T2 and T7 were higher than that at T0: 7.5 (3) and 6.7 (5.5) versus 5 (2.5), respectively (all p < 0.05). The opioid escalation index at T7 was 1.7%. The median (IQR) number of rescues, stabilization dose, and time for stabilization was 0 (1), 5(4.5) mg, and 3(2) days, respectively. Two patients were discontinued due to delirium. All other side effects were mild. Conclusions: First-line, low-dose methadone using rescue methadone resulted in a pronounced and rapid decrease in pain, with minimal need for titration and for breakthrough doses, and no evidence of accumulation or sedation by the end of the week.
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
Springer
dc.rights
info:eu-repo/semantics/restrictedAccess
dc.rights.uri
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.subject
ADVANCED CANCER
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CANCER PAIN
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FIRST-LINE METHADONE
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TITRATION
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Oncología
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Medicina Clínica
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CIENCIAS MÉDICAS Y DE LA SALUD
dc.title
First-line methadone for cancer pain: titration time analysis
dc.type
info:eu-repo/semantics/article
dc.type
info:ar-repo/semantics/artículo
dc.type
info:eu-repo/semantics/publishedVersion
dc.date.updated
2022-08-16T18:16:55Z
dc.journal.volume
29
dc.journal.number
11
dc.journal.pagination
6335-6341
dc.journal.pais
Alemania
dc.journal.ciudad
Berlín
dc.description.fil
Fil: Mammana, Guillermo. Hospital de Agudos Dr. E. Tornú; Argentina
dc.description.fil
Fil: Bertolino, Mariela. Hospital de Agudos Dr. E. Tornú; Argentina
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Fil: Bruera, Eduardo Pedro. University of Texas Health Science Center at Houston. University of Texas Md Anderson Cancer Center; Estados Unidos
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Fil: Orellana, Fernando. Hospital de Agudos Dr. E. Tornú; Argentina
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Fil: Vega, Fanny. Hospital de Agudos Dr. E. Tornú; Argentina
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Fil: Peirano, María Gabriela. Hospital de Agudos Dr. E. Tornú; Argentina
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Fil: Bunge, Sofia. Hospital de Agudos Dr. E. Tornú; Argentina. Universidad Nacional del Centro de la Pcia.de Bs.as.. Facultad de Ciencias de la Salud.; Argentina
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Fil: Armesto, Arnaldo Raúl. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina
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Fil: Dran, Graciela Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Facultad Latinoamericana de Ciencias Sociales. Sede Academica Argentina Bs.as.. Departamento de Bioetica y Cuidados Paleativos.; Argentina
dc.journal.title
Supportive Care In Cancer
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/https://link.springer.com/10.1007/s00520-021-06211-y
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/https://doi.org/10.1007/s00520-021-06211-y
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