Department of Neurosurgery, Georg August Universität of Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
Neurosurg Rev. 2021 Feb;44(1):579-586. doi: 10.1007/s10143-020-01250-1. Epub 2020 Feb 14.
It was suggested that D, L-Methadone might improve the clinical course of glioma patients. Owing to massive press coverage, patients demand the prescription of D, L-Methadone, but regarding its adjunctive use in glioma therapy there is no standard medication plan. Furthermore, it is not known which side effects the administration of D, L-Methadone might harbor, especially if the patients are opioid-naïve and if D, L-Methadone therapy was managed by the patients themselves or their general practitioners. Opioid-naïve patients with high-grade glioma (new diagnosis or recurrent) receiving D, L-Methadone were included in this retrospective observational analysis. Side effects were assigned if the condition deteriorated in conjunction with the initiation of D, L-Methadone and resolved/ ameliorated after cessation of the intake/reduction of the dosage. Side effects were categorized according to the common toxicity criteria (CTC). Twenty-four patients were included. All patients were opioid-naïve and received D, L-Methadone from their general practitioners. Sixteen patients experienced side effects. The median dosage when side effects began to occur was 15.8 mg/ 24 h. Fatigue and mood changes were reported most frequently (14 of 24 patients). Five patients had severe side effects related to relatively high doses. In all cases, symptoms resolved after cessation or dose reduction. Our results show that D/L M intake lead to frequent occurrence of side effects in opioid-naïve patients especially when not handled with caution and close supervision. Patients, their relatives, their GPs and neuro-oncologists need to be informed about the broad spectrum of side effects in order to thoroughly counsel glioma patients.
有人提出 D,L-美沙酮可能改善神经胶质瘤患者的临床病程。由于大量媒体报道，患者要求开 D,L-美沙酮处方，但关于其在神经胶质瘤治疗中的辅助应用尚无标准的用药方案。此外，尚不清楚 D,L-美沙酮给药可能会带来哪些副作用，尤其是在患者为阿片类药物初治且 D,L-美沙酮治疗由患者自己或其全科医生管理的情况下。这项回顾性观察性分析纳入了初治（新发或复发）高级别神经胶质瘤且接受 D,L-美沙酮治疗的阿片类药物初治患者。如果在开始使用 D,L-美沙酮时病情恶化且停止使用/减少剂量后得到缓解/改善，则将其归为副作用。根据常见毒性标准（CTC）对副作用进行分类。共纳入 24 例患者。所有患者均为阿片类药物初治，且由全科医生开具 D,L-美沙酮处方。16 例患者出现副作用。出现副作用时的中位剂量为 15.8mg/24h。疲劳和情绪变化的报告最为频繁（24 例患者中有 14 例）。5 例患者因相对较高剂量出现严重副作用。所有病例在停止使用或减少剂量后症状均得到缓解。我们的研究结果表明，在阿片类药物初治患者中，D/L 美沙酮的摄入会导致频繁出现副作用，尤其是在处理不谨慎和缺乏密切监督的情况下。需要告知患者、其亲属、全科医生和神经肿瘤学家，以便为神经胶质瘤患者提供全面的咨询。
