Resumen

PAPA DE LA ROSA, Patricia. Rotación a metadona para el dolor por cáncer: estudio prospectivo. Anest Analg Reanim [online]. 2009, vol.22, n.2, pp.31-37. ISSN 1688-1273.

SUMMARY The aim of this study was to evidence the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. Seventeen advanced cancer patients receiving morphine but with uncontrolled pain or severe opioid adverse effects were switched to oral methadone administered every 8 or 12 hours according to a scheme of rapid switching using different dose ratios. Intensity of pain and adverse effects were assessed daily and compared before and after switching. Pre switching doses of morphine, initial, day 7 and final methadone doses were recorded. Before the switch, the median equivalent daily dose of morphine was 118.71 mg/day; after the switch the initial dose of methadone (median) was 17.94 mg/day, 27.06 mg/day at day 7 and the final dose of methadone (median) was 34.12 mg/day. The reasons for switching were: uncontrolled pain, adverse effects or both. Significant improvements in pain (p<0.05) and relevant changes in adverse effects were reported. Methadone - related side effects reported in 8 patients were relieved after treatment. In patients with cancer pain and/or adverse effects of oral methadone is a valid therapeutic option. Caution is recommended when switching from any opioid to methadone, in patients who are tolerant to high doses of opioids.

Palabras clave : Opioids, dose ratio, opioid rotation, opioid toxicity, uncontrolled pain, methadone.

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