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Comparison of a novel methadone rotation method with other commonly used methods
  1. Elaine Cunningham1,
  2. Nicole DiBiagio2,
  3. Florry O’ Connell3,
  4. Maedhbh Flannery4,
  5. Michael Cronin5,
  6. Marie Murphy3,
  7. Mary Jane O’Leary6,
  8. Fiona Kiely3 and
  9. Aoife C Lowney7,8
  1. 1Palliative medicine, Marymount University Hospital and Hospice, Cork, Ireland
  2. 2School of Medicine and Health, University College Cork, Cork, Ireland
  3. 3Palliative Medicine, Marymount University Hospital and Hospice, Cork, Cork, Ireland
  4. 4Pharmacy, Marymount University Hospital and Hospice, Cork, Cork, Ireland
  5. 5Department of Statistics, University College Cork, Cork, Cork, Ireland
  6. 6Department of Palliative Care, Marymount University Hospital and Hospice, Cork, Cork, Ireland
  7. 7Palliative Care, Marymount University Hospital and Hospice, Cork, Cork, Ireland
  8. 8Palliative Care, Cork University Hospital, Cork, Cork, Ireland
  1. Correspondence to Dr Elaine Cunningham; elainecunningham180{at}gmail.com

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.

  • Pain
  • Palliative care
  • Drug administration

https://doi.org/10.1136/spcare-2024-005147

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    Footnotes

    • Contributors Project design and implementation performed by EC, NDB and ACL. Eligible participants identified by MF. Data collection performed by EC and NDB. Statistics were performed by MC. Manuscript drafted by EC. Manuscript review and revisions were conducted by EC, NDB, FOC, MF, MC, MM, MJOL, FK and ACL. EC is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.