Ramkiran S, Thota Raghu S
Department of Anaesthesiology, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Vishakapatnam, Andhra Pradesh, India.
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Palliat Care. 2020 Apr-Jun;26(2):215-220. doi: 10.4103/0973-1075.285690.
Methadone has been an unique, versatile, cost effective, synthetic opioid utilized in nociceptive as well as neuropathic pain. Pain and palliative care physicians started accepting methadone in treatment of complex pain associated with advanced cancer and neuropathic pain syndromes in which conventional opioids were no longer effective. The challenge is in accepting methadone as a main stream first line opioid, from being considered as a second line replacement/substitution drug all these years. Methadone has a significant role as opioid rotation in refractory cancer pain, especially when started early leading to successful conversion. Advantages of methadone in paediatric patients with advanced cancer were its safety and efficacy as a first-choice opioid, availability as a liquid formulation and its infrequent dose requirements. Methadone is neither recommended nor justified to be used as an anti-cancer drug and its role as an anti-cancer agent is a misconception. Many guidelines were proposed after 2008 to address methadone safety. Most of them emphasized on prevention of cardiac arrhythmia and association of methadone with QTc prolongation rather than address the real issue. Methadone has been established to be safe when used in opioid naïve patients with careful titration instituted in an ambulatory setting and has equal success in opioid rotation in outpatient setup. Methadone prescription should be carried out by experienced pain and palliative care providers with careful dose titration and clinical monitoring.
美沙酮是一种独特、用途广泛、性价比高的合成阿片类药物，用于治疗伤害性疼痛和神经性疼痛。疼痛与姑息治疗医生开始接受美沙酮用于治疗与晚期癌症相关的复杂疼痛以及常规阿片类药物不再有效的神经性疼痛综合征。挑战在于如何让美沙酮从多年来一直被视为二线替代药物转变为被接受为主流一线阿片类药物。美沙酮在难治性癌症疼痛的阿片类药物轮换中具有重要作用，尤其是早期开始使用时能成功实现转换。美沙酮在患有晚期癌症的儿科患者中的优势在于其作为首选阿片类药物的安全性和有效性、有液体制剂以及剂量需求不频繁。美沙酮既不被推荐也不合理地用作抗癌药物，其作为抗癌剂的作用是一种误解。2008年后提出了许多指南来解决美沙酮的安全性问题。其中大多数强调预防心律失常以及美沙酮与QTc延长的关联，而不是解决实际问题。已证实美沙酮在初用阿片类药物的患者中谨慎滴定使用时是安全的，并且在门诊环境中的阿片类药物轮换中同样成功。美沙酮处方应由经验丰富的疼痛与姑息治疗提供者进行，仔细进行剂量滴定并进行临床监测。
