title: Methadone is safe for treating hospitalized patients with severe pain.
abstract: OBJECTIVE
  Methadone is still regarded as a second line opioid for patients suffering from severe pain, and is rarely used in hospitalized patients. The infrequent use of methadone is probably due to its long plasma half-life that could lead to accumulation and toxicity. In the present study we report that clinically effective analgesic doses of methadone, given either epidurally or orally, can be used safely for prolonged treatment in hospitalized patients.
  
  
  METHODS
  Over a five-year period we administered methadone at Hadassah Hospital in Jerusalem to 3,954 in-patients with severe pain, 12% of whom were younger than 17 yr. Satisfactory pain relief was recorded in more than 85% of the patients. None of the patients treated with oral methadone developed serious side effects. Three patients, treated with epidural methadone (0.09%), developed a clinically significant respiratory depression. In all three cases, epidural pump failure or pump misprogramming resulted in methadone overdose. None of the children or adults treated with methadone developed addiction during hospitalization.
  
  
  CONCLUSIONS
  Based on its analgesic properties and marked safety profile, we suggest that methadone could be added to the analgesic armamentarium of in-hospital health-care providers. Moreover, methadone could serve as the opioid of first choice in some in-patient populations.
authors.affiliation: Pain Relief Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Shir
authors.forename: G
authors.initials: G
authors.lastname: Rosen
authors.forename: A
authors.initials: A
authors.lastname: Zeldin
authors.forename: E M
authors.initials: EM
authors.lastname: Davidson
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement / Q000187:drug effects; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone