Initiation Dose Strong opioids Baseline tend assessment to before initiation Initiated under cause similar Serum undesirable electrolytes specialist palliative effects, albeit ECG to varying if history cardiac conduction medicine degrees, the abnormalities, frequency is advanced heart disease or consultants not defined, ischemic but reported heart disease, family history of supervision undesirable sudden effects include; death, concomitant treatment with Anorexia drugs that have the potential for Asthenia and/or drugs that may cause Maintenance dose daily Biliary pain electrolyte abnormalities maintenance dose Confusion will be established Constipation Ongoing monitoring by specialist Drowsiness If patient with recognised risk factors for palliative medicine Dry mouth QT-prolongation should be carefully consultants. Dyspepsia monitored taking methadone: heart or Exacerbation liver disease, of electrolyte abnormalities, or Maintenance doses pancreatitis concomitant treatment with drugs that can vary considerably, Euphoria prolong Insomnia QT interval; patients requiring but most are Headaches >100mg daily. This includes electrolyte <80mg/24h, Hyperhidrosis and ECG monitoring if appropriate. When however in some Myoclonus reviewing the patients the specialist will cases higher doses Nausea take in to consideration the risks versus may be required. Pruritus benefits of the treatment, and depending Sexual dysfunction on the stage (e.g. of the illness whether or not amenorrhea, it is appropriate decreased for on going libido, erectile ECG/electrolyte monitoring. dysfunction) Urinary Review retention patient for continued need of Vertigo medication and dose escalation retaining Visual patients disturbance on doses >100mg daily Vomiting Review patient on request from GP (if and Excessive when dose: required)
Initiation Dose Initiated under specialist palliative medicine consultants supervision Maintenance dose daily maintenance dose will be established by specialist palliative medicine consultants. Maintenance doses vary considerably, but most are <80mg/24h, however in some cases higher doses may be required. Strong opioids tend to cause similar undesirable effects, albeit to varying degrees, the frequency is not defined, but reported undesirable effects include; Anorexia Asthenia Biliary pain Confusion Constipation Drowsiness Dry mouth Dyspepsia Exacerbation of pancreatitis Euphoria Insomnia Headaches Hyperhidrosis Myoclonus Nausea Pruritus Sexual dysfunction (e.g. amenorrhea, decreased libido, erectile dysfunction) Urinary retention Vertigo Visual disturbance Vomiting Excessive dose: Baseline assessment before initiation Serum electrolytes ECG if history cardiac conduction abnormalities, advanced heart disease or ischemic heart disease, family history of sudden death, concomitant treatment with drugs that have the potential for and/or drugs that may cause electrolyte abnormalities Ongoing monitoring If patient with recognised risk factors for QT-prolongation should be carefully monitored taking methadone: heart or liver disease, electrolyte abnormalities, or concomitant treatment with drugs that can prolong QT interval; patients requiring >100mg daily. This includes electrolyte and ECG monitoring if appropriate. When reviewing the patients the specialist will take in to consideration the risks versus benefits of the treatment, and depending on the stage of the illness whether or not it is appropriate for on going ECG/electrolyte monitoring. Review patient for continued need of medication and dose escalation retaining patients on doses >100mg daily Review patient on request from GP (if and when required)
Palliative-Care-Guidance-Methadone-V2.0.docx