Comparison of a novel methadone rotation method with other commonly used methods
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Accepted Version
Supplementary Material
Date
2024
Authors
Cunningham, Elaine
DiBiagio, Nicole
O’Connell, Florry
Flannery, Maedhbh
Cronin, Michael
Murphy, Marie
O’Leary, Mary Jane
Kiely, Fiona
Lowney, Aoife C.
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Published Version
Abstract
Objectives To compare a novel method of methadone rotation used in a specialist palliative care inpatient unit (SPCU) in Cork, Ireland, with rapid titration methods using Perth and Brisbane Protocols as well as the Edmonton method of methadone rotation.
Methods A retrospective chart review was performed in March–June 2022. All patients who completed rotation to methadone during 2018–2019 in the SPCU were included. 2018–2019 was selected to study a population not affected by the coronavirus pandemic. Oral morphine equivalent (OME) was calculated using the opioid conversion chart. From the OME, the expected daily methadone dose was calculated using the Perth, Brisbane and Edmonton methods. These figures were then compared directly with the actual methadone doses achieved using our dosing schedule.
Results A comparison of the expected doses using the Perth and Brisbane rapid titration protocols and stable daily dose achieved revealed that the stable methadone dose was significantly lower than both rapid titration protocols (p=<0.0001) and (p=0.0035, respectively). However, a comparison of the expected dose using the Edmonton method and the dose achieved did not determine any significant difference (p=0.7602).
Conclusions This is the first evaluation of a novel Irish method of methadone rotation and demonstrates a lower overall daily methadone dose compared with established protocols.
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Keywords
Pain , Palliative care , Drug administration
Citation
Cunningham, E., DiBiagio, N., O’ Connell, F., Flannery, M., Cronin, M., Murphy, M., O’Leary, M.J., Kiely, F. and Lowney, A.C. (2024) ‘Comparison of a novel methadone rotation method with other commonly used methods’, BMJ Supportive & Palliative Care, p. spcare-2024-005147. https://doi.org/10.1136/spcare-2024-005147
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© 2024, the Author(s). Published by BMJ Publishing Group Ltd. This article has been accepted for publication in BMJ Supportive & Palliative Care, 2024 following peer review, and the Version of Record can be accessed online at https://doi.org/10.1136/spcare-2024-005147