title: Practicability, safety, and efficacy of a "German model" for opioid conversion to oral levo-methadone.
abstract: BACKGROUND
  An algorithm to convert from any other opioid to oral levo-methadone was developed in Germany, the German model of levo-methadone conversion (GMLC). According to this GMLC, the pre-existing opioid is stopped, then titration of oral levo-methadone is initiated with a starting dose of 5 mg orally q 4 h (plus prn q 1 h). If necessary, levo-methadone dose is increased (pain) or decreased (side effects) by 30% q 4 h (plus prn q 1 h). After 72 h, the achieved single dose is maintained, but the dosing interval increases twofold to q 8 h (plus prn q 3 h). The aim of this study was to obtain information about the practicability, safety, and efficacy of the GMLC in clinical routine.
  
  
  METHODS
  A retrospective, systematic chart review of levo-methadone conversions for the treatment of pain in inpatient palliative care was performed.
  
  
  RESULTS
  Fifty-two patients were analyzed. The dosing interval was increased correctly after 72 h as demanded by the GMLC in 60% of patients. In 85% of the patients, opioid medication with levo-methadone could be maintained until the end of the inpatient stay. In three patients (6%), levo-methadone administration had to be stopped due to side effects. No serious adverse events could be detected during opioid rotation. Pain intensity was reduced significantly (p < 0.001) after conversion concerning mean (NRS 0.9; range 0-4) and maximum pain over the day (NRS 3.9; range 0-10).
  
  
  CONCLUSIONS
  The presented study indicates that the GMLC provides a practical and reasonably safe approach to perform opioid rotation to levo-methadone in a palliative care setting.
authors: Division of Palliative Medicine, University of Erlangen, Erlangen, Germany. christoph.ostgathe@uk-erlangen.de
authors: Christoph
authors: C
authors: Ostgathe
authors: Raymond
authors: R
authors: Voltz
authors: Annika
authors: A
authors: Van Aaaken
authors: Carsten
authors: C
authors: Klein
authors: Rainer
authors: R
authors: Sabatowski
authors: Friedemann
authors: F
authors: Nauck
authors: Jan
authors: J
authors: Gaertner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008485:Medical Audit; D008691:Methadone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D008962:Models, Theoretical; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013237:Stereoisomerism
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone