Mott Christine, Sarpal Amrita, Moss Krista, Herbert Anthony
Lady Cilento Children's Hospital, Brisbane 4069, Australia.
Children's Hospital London Health Sciences Centre, London, ON N6A 5W9, Canada.
Children (Basel). 2018 Jun 27;5(7):86. doi: 10.3390/children5070086.
Methadone has the potential to assist in the management of pain in children with life-limiting illness, but its use is limited by its complex pharmacokinetic profile and limited research on its use in children. This is a retrospective review of the use of methadone as an analgesic in 16 children with life-limiting illness. Efficacy, dosing and side effect profile were analysed. Fifteen (94%) patients had improvements in their analgesia with minimal observed adverse effects. Patients were either rapidly converted from a prior opioid in one change or received methadone as an adjunct medication. Conversions were calculated using ratios frequently in the range of 10:1 to 20:1 from the oral morphine equivalent total daily dose (MEDD). Adjunct initial dosing was a low dose trial, often beginning with 1 mg at night. Only two patients required a dose adjustment due to side effects attributed to methadone. This was despite the cohort having significant underlying illnesses, extensive concurrent medications, and high methadone dosing where needed. Analysis of dosing and ratios indicates that an individualised approach is required. Based on this and on the infrequency of methadone use in this population, specialist assistance with dosing is recommended. Further research, including prospective and pharmacokinetic studies, is recommended.
美沙酮有潜力辅助治疗患有危及生命疾病的儿童的疼痛，但因其复杂的药代动力学特性以及在儿童中使用的研究有限，其应用受到限制。这是一项对16名患有危及生命疾病的儿童使用美沙酮作为镇痛药的回顾性研究。分析了疗效、剂量和副作用情况。15名（94%）患者的镇痛效果有所改善，观察到的不良反应最小。患者要么在一次换药中迅速从先前的阿片类药物转换过来，要么将美沙酮作为辅助药物使用。转换是根据口服吗啡等效每日总剂量（MEDD），使用通常在10:1至20:1范围内的比率进行计算的。辅助初始剂量是低剂量试验，通常从每晚1毫克开始。只有两名患者因美沙酮引起的副作用需要调整剂量。尽管该队列有严重的基础疾病、大量的合并用药以及在需要时使用了高剂量美沙酮，但情况依然如此。剂量和比率分析表明需要采用个体化方法。基于此以及该人群中美沙酮使用频率较低的情况，建议在剂量方面寻求专科医生的帮助。建议开展进一步研究，包括前瞻性研究和药代动力学研究。
