University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
University of Maryland School of Pharmacy, Baltimore, Maryland, USA; MedStar Health, Baltimore, Maryland, USA.
J Pain Symptom Manage. 2019 Mar;57(3):635-645.e4. doi: 10.1016/j.jpainsymman.2018.12.001. Epub 2018 Dec 20.
Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy.
美沙酮具有一些独特的特性，使其成为治疗严重疾病疼痛的一种有吸引力的选择，但近年来阿片类药物引起的死亡人数不成比例增加的报道使美沙酮的安全性受到质疑。美国疼痛学会、药物依赖问题学会和心律学会合作制定了关于最大限度提高美沙酮安全性和疗效的最佳实践指南，但临终场景的指南尚未制定。2015 年 2 月，来自美国和加拿大的 15 名跨专业临终关怀和姑息治疗专家小组召开会议，评估美国疼痛学会关于美沙酮在临终关怀和姑息治疗环境中应用的建议的适用性。其目标是制定临终关怀和姑息治疗中美沙酮治疗安全有效的管理指南。本文代表临终关怀和姑息治疗专家对美沙酮在生命末期使用的共识意见，包括美沙酮的合适候选者指导、剂量、滴定和监测患者对美沙酮治疗的反应的详细信息。
