Use of methadone in a highly tolerant patient receiving parenteral hydromorphone.
A 59-year-old woman with metastatic breast cancer experienced a poor response 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 as an adjuvant and eventually as the sole analgesic, at a much smaller dose than expected resulted in very satisfactory analgesia, without the development of serious side effects. In addition, the cost of treatment decreased to less than $25 per day. This case illustrates the rationale and advantages for the use of methadone. Intraindividual variability in the response to various opioids is a factor to be considered when selecting analgesics. Methadone is a useful second-line or third-line opioid for the patient who is highly tolerant to other opioids, as it may demonstrate incomplete cross-tolerance with other agonist opioids. Switching of the opioid to methadone may be a worthwhile option to consider in managing patients who are highly tolerant to other opioids.
Thomas
Z
Z
Regina Palliative Care Program, University of Saskatchewan, Regina, Canada.
Bruera
E
E
D001943:Breast Neoplasms / Q000188:drug therapy / Q000556:secondary; D016527:Drug Costs; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000191:economics / Q000627:therapeutic use*; D007263:Infusions, Parenteral; D008691:Methadone / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D010166:Palliative Care
D004091:Hydromorphone; D008691:Methadone