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[A Case of Methadone Induced Drowsiness Following Trabectedin Induced Liver Injury]

Masaki Shimizu1, Masaki Higuchi, Hiroto Ishiki

  • 1Dept. of Palliative Medicine, National Cancer Center Hospital.

Gan to Kagaku Ryoho. Cancer & Chemotherapy
|July 13, 2019
PubMed

Insights

A patient with malignant fibrous histiocytoma experienced severe drowsiness due to impaired methadone metabolism after liver injury. Reducing the methadone dose and providing liver support effectively resolved the drowsiness.

Area of Science:

  • Oncology
  • Pharmacology
  • Hepatology

Background:

  • Malignant fibrous histiocytoma is a rare soft tissue sarcoma.
  • Effective pain management is crucial for patients with advanced cancer.
  • Methadone is an effective opioid analgesic for cancer pain.
  • Trabectedin is a chemotherapeutic agent with potential hepatotoxicity.

Observation:

  • A 66-year-old male patient with malignant fibrous histiocytoma presented with severe arm and shoulder pain.
  • Methadone (45 mg/day) provided significant pain relief.
  • The patient developed severe drowsiness after initiating trabectedin therapy, suggesting drug-induced liver injury and altered methadone metabolism.

Findings:

  • Impaired methadone metabolism secondary to trabectedin-induced liver injury was suspected as the cause of severe drowsiness.
  • A reduction in methadone dosage combined with liver-supportive therapy successfully alleviated the patient's drowsiness.

Implications:

  • This case highlights the importance of monitoring opioid metabolism in cancer patients with drug-induced liver injury.
  • Clinicians should consider dose adjustments for methadone and implement liver support in similar clinical scenarios.
  • Further research into drug-drug interactions and metabolic pathways in oncology patients is warranted.

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