Discussion on methadone initiation protocols: A case report

Matthieu Delaye, MD; Sophie Laurent, MD; Mélanie Try, MD; Erwan Treillet, MD

doi:10.5055/jom.2022.0742

Authors

Matthieu Delaye, MD https://orcid.org/0000-0002-2435-4757
Sophie Laurent, MD
Mélanie Try, MD
Erwan Treillet, MD

DOI:

https://doi.org/10.5055/jom.2022.0742

Keywords:

methadone, opioid rotation, cancer pain, methadone initiation

Abstract

Through a concrete case, we discuss the main published protocols to initiate methadone and illustrate the advantages and disadvantages of rapid or gradual initiation and on-demand or fixed doses with rescue doses. Daily doses can vary widely depending on the protocol chosen. An on-demand administration could lead to an overdose as illustrated in our case. A better understanding of particularities and limitations of these protocols could lead to safer methadone initiation. Systematic comparison of different protocols and calculation of the daily dose should be a standard in clinical practice.

Author Biographies

Matthieu Delaye, MD

Pain Management Unit, Gustave Roussy Institute, Villejuif, France

Sophie Laurent, MD

Pain Management Unit, Gustave Roussy Institute, Villejuif, France

Mélanie Try, MD

Nephrology Department, Bicetre Hospital, Paris-Saclay University, le Kremlin-Bicêtre, France

Erwan Treillet, MD

Pain Management Unit, Colmar Hospital, France

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