Journal of opioid management
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Case Reports
Fluctuating QTc interval in an asymptomatic patient treated with methadone for chronic pain.
Prolongation of the QT interval associated with ventricular arrhythmias has been the most common cause of the restriction or withdrawal of drugs from the market in the past 10 years. Methadone, a synthetic opioid that is increasingly used for the management of chronic pain, has recently been implicated in the development of the prolonged QT syndrome. ⋯ After reviewing the current literature, we suggest that there is no dose of methadone that may be considered to be completely safe. Other risk factors for prolonged QT interval such as underlying cardiac abnormalities, electrolyte disturbances, and concurrent medications should be sought, and all patients should be monitored with serial ECGs even when methadone doses remain stable.
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DepoDur is a unique delivery system that has a Food and Drug Administration-approved recommended close of 15 mg for orthopedic lower extremity surgery and a 10- to 15-mg dose for lower abdominal or pelvic surgery. Some patients may benefit from a 20-mg dose, but the incidence of serious adverse respiratory events has been close related in clinical trials. ⋯ The unique delivery system requires additional safety and storage precautions. The clinical studies to date do not show DepoDur administration to have any lower adverse reaction profile compared to standard epidural morphine.
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Breakthrough pain is a transitory flare of pain occurring in most cancer patients against a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. ⋯ This review article aims to present the role of oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer patients. In particular, it is going to discuss the synthesis, clinical pharmacology, pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.