Watanabe S, Belzile M, Kuehn N, Hanson J, Bruera E
Palliative Care Program, Edmonton General Hospital, Alberta, Canada.
Cancer Treat Rev. 1996 Jan;22 Suppl A:131-6. doi: 10.1016/s0305-7372(96)90075-4.
The dose ratio, analgesic efficacy, toxicity and cost of methadone for cancer pain were evaluated in a retrospective review of 50 consecutive patients treated on a Palliative Care Unit. Patients were switched from hydromorphone 267.7 +/- 178.8 mg sc per day to custom-made capsules (24) or suppositories (26) of methadone for reasons of uncontrolled pain (24), toxicity (8), both (15) or other (2). The change in opioid occurred over 2.5 +/- 3.6 days, with another 4.4 +/- 3.7 days required to reach stable methadone dose. The ratio of stable methadone dose to final hydromorphone dose was 1.07 +/- 0.9 (oral) and 1.88 +/- 1.27 (rectal) (p = 0.01). Visual analogue scores for pain intensity (0-100 mm) declined from 50.8 +/- 22 to 40 +/- 20 (p = 0.01). The most frequent toxicities were constipation (46), sedation (42) and nausea (18). Six patients developed respiratory depression. Total cost of treatment was Canadian $116.77 +/- 157.17 for methadone capsules and Canadian $105.34 +/- 146.35 for methadone suppositories, vs Canadian $3450.51 +/- 5098.58 (p = 0.0001) for hydromorphone parenteral solution and Canadian $1801.21 +/- 2661.52 (p = 0.0001) for hydromorphone powder. It is concluded that methadone is an effective and inexpensive alternative in patients receiving high-dose opioids for cancer pain, at dose ratios much lower than recommended in the literature. The incidence of serious toxicities suggests that methadone should only be initiated in an adequately monitored setting by pain management experts.
在对姑息治疗病房连续治疗的50例患者进行的回顾性研究中，评估了美沙酮用于癌症疼痛的剂量比、镇痛效果、毒性和成本。由于疼痛控制不佳（24例）、毒性反应（8例）、两者皆有（15例）或其他原因（2例），患者从每天皮下注射267.7±178.8毫克氢吗啡酮改为使用定制的美沙酮胶囊（24例）或栓剂（26例）。阿片类药物的更换在2.5±3.6天内完成，达到美沙酮稳定剂量还需要另外4.4±3.7天。稳定美沙酮剂量与最终氢吗啡酮剂量的比值，口服为1.07±0.9，直肠给药为1.88±1.27（p = 0.01）。疼痛强度视觉模拟评分（0 - 100毫米）从50.8±22降至40±20（p = 0.01）。最常见的毒性反应是便秘（46例）、镇静（42例）和恶心（18例）。6例患者出现呼吸抑制。美沙酮胶囊的治疗总成本为116.77加元±157.17加元，美沙酮栓剂为105.34加元±146.35加元，而氢吗啡酮注射剂为3450.51加元±5098.58加元（p = 0.0001），氢吗啡酮粉剂为1801.21加元±2661.52加元（p = 0.0001）。结论是，对于接受高剂量阿片类药物治疗癌症疼痛的患者，美沙酮是一种有效且廉价的替代药物，其剂量比远低于文献推荐值。严重毒性反应的发生率表明，美沙酮仅应由疼痛管理专家在充分监测的环境中启动使用。
