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Methadone: Maximizing Safety and Efficacy for Pain Control in Patients with Cancer
Mary Lynn McPherson1, Ryan C Costantino2, Alexandra L McPherson2
1Advanced Post-Graduate Education in Palliative Care, Online Master of Science and Graduate Certificates in Palliative Care, University of Maryland School of Pharmacy, 20 North Pine Street, S405, Baltimore, MD 21201, USA.
Abstract:
Methadone is a valuable opioid in the management of patients who have cancer with pain. Methadone is a mu-, kappa-, and delta-opioid agonist, and an N-methyl-D-aspartate receptor antagonist. These mechanisms of action make methadone an attractive option for complex pain syndromes. It is critically important that providers consider a patient's risk status before beginning methadone. Careful consideration must be given to dosing methadone in both opioid-naïve and opioid-tolerant patients, with vigilant monitoring for therapeutic effectiveness and potential toxicity until the patient achieves steady state.
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