Methadone

Question 1

How to perform an Opioid Rotation
- Without Methadone

Answer 1

Morphine = 10 mg
Tramadol = 100 mg
Codeine = 100 mg
Hydromorphone = 2 mg
Oxycodone = 7.5 mg

Question 2

How to perform an Opioid Rotation
- To Methadone

Answer 2

Greater number is morphine
- oMEDD < 1g mg/day use 10:1
- oMEDD 1-3g mg/day use 20:1
- oMEDD 3-10 mg/day use 30:1
- oMEED >10 mg/day use 50:1

Divided into q8h dosing

Then Edmonton Method

Question 3

Edmonton Method

Answer 3

4 Days
- Reduce ATC Dose of original opioid by 33% each day
- Introduce 33% of calculated methadone each day

Day 4 can use methadone as breakpoint or just use original opioid
- Methadone can accumulate and some patients can not tolerate

Question 4

How to calculate breakthrough doses

Answer 4

10% of Total Daily Dosing

Question 5

Long-Acting Agents
- Options

Answer 5

Morphine
Oxycodone
Hydromorphone
Codeine
Tramadol

Methadone

Question 6

Long-Acting Agents
- Dosing Frequency

Answer 6

Dosed every 12 hours or daily

Methadone
- Every 8 hours

Kadian (Morphine 24 hours)
- Dosed every 24 hours

Question 7

Long-Acting Agents
- Titration

Answer 7

Should not be used when titrating
- Use immediate release instead until pain has stabilized

Question 8

Long-Acting Agents
- Kadian Interchangeable

Answer 8

Not interchangeable with MS contin or M-Eslon or other Morphines
- Releases over 24 hours NOT 12 hours

Question 9

Converting Short Acting Opioid to Long Acting Opioid

Answer 9

Total dose of immediate acting opioid / # of doses per day

Question 10

Converting from Oral to Parenteral Dosing

Answer 10

50% of oral dose is the parenteral dose
- Can be done if oral dose is not tolerated (nausea)

Question 11

Reasons to perform opioid rotation

Answer 11

Inadequate pain control

Toxicities
- Constipation
- NV
- Drowsiness