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ECHO Hamrahi 6th session 10 May 2022

Methadone in pain management

Didactic by Dr Sunil Kumar Mupliyath

Case presentation by Dr Jessica Mather-Hillon

Factors which make prescribing methadone stressful/difficult:

  • Unfamiliarity with the drug
  • Used for unstable patients with poorly controlled pain, in what may already be a stressful situation
  • Toxicities and interactions
    • Many potential drug interactions, which may increase or decrease bioavailability of methadone
  • Long time to steady state which also varies according to age and hepatic function
  • Complexities of converting from a different opioid to methadone, with conversion ratios changing as previous MEDD rises

However, developing expertise in prescribing methadone for pain management is important because:

  • It can be used at a low dose as an adjuvant analgesic with actions beyond opioid receptors
    • Therefore has a role in treating neuropathic pain, opioid poorly responsive pain, when opioid tolerance is diagnosed
  • It is recommended for patients with severe renal impairment such as hepatic metabolism
  • Once steady state reached, can dose twice a day, so effectively as a long acting opioid which is important when slow release morphine formulations are unavailable or too expensive.
  • It is affordable
  • If an institution has RMI, they can order methadone as well as morphine. NB RMI is not specific to any particular opioid. It allows institution to order any opioid.
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