Index. E Elderly. See also Older patients analgesic efficacy and opioid adverse effects, 280

Transcription

1 A Acute pain, methadone maintained patients, 33 Addiction antisocial behaviors, 24 definition, 15 Drug Addiction Treatment Act 2000, 140 heroin, 41 morphine, 91 opioid, 16 related counseling, 23 treatment reimbursement, 158 stable methadone doses, 45 American Pain Society (APS), 5, 264 Analgesia, 167 exit strategies, 222 hydrocodone/oxycodone, 214 injectable form, 216 management, 214 methadone (see Methadone analgesia) older patients acute pain, 277 (see Buprenorphine) methadone (see Methadone) opioids, 280 persistent pain, 277 pharmacodynamic changes, 279 pharmacokinetic changes (see Pharmacokinetics) opioid rotations, 215 patient care, 214 patient nonadherence, 43 SCD, 265, 269, 270 Analgesic efficacy, heterogeneous pain conditions, malignant diseases, non-cancer pain conditions, Analgesic tolerance, description, 127 retrospective data analysis, Antiretroviral combination therapy benzodiazepines, 191, 193 lithium, 194 MAOIs, 194 NNRTI and PI antivirals, 191, 192 serotonin reuptake inhibitors, 194 Antiretrovirals agents and effects, 189, 190 benzodiazepines, 191, 193 cocaine, 195 lithium and anticonvulsants, 194 MAOIs, 194 NNRTIs, 190 NRTIs, PIs, rifampin, serotonin reuptake inhibitors, 194 APS. See American Pain Society (APS) B Benzodiazepines, 42, 43, 45, 48 Breakthrough pain (BTP), 254 methadone, Breastfeeding maintenance treatment, 233 MMT, 231 BTP. See Breakthrough pain (BTP) R.A. Cruciani and H. Knotkova (eds.), Handbook of Methadone Prescribing and Buprenorphine Therapy, DOI / , Springer Science+Business Media New York

2 290 Buprenorphine analgesic activity, 164 tolerance (see Analgesic tolerance, ) applications, 132 benefits, 163 BUP-TDS efficacy heterogenous populations, neuropathic pain, 115 nociceptive pain conditions, chronic pain conditions ( see Chronic pain, ) clinical safety and cost-effectiveness (see Safety, ) description, 109, 163 drug drug interactions, effects fetal and neonatal, 233 long-term, 233 elimination, 109 formulations, maintenance therapy (see Maintenance therapy, ) metabolism (see Metabolism) older patients (see Older patients, ) opioid debt, opioid rotations (see Opioid rotations) pain ceiling effect, 255 classification, 249 human trials, neuropathic pain syndromes, 255 pain management (see Pain management) patient (see Patient) pharmacological profile (see Pharmacology) TDS formulation, 250 partial μ agonist medications, 214 pharmacodynamics (see Pharmacodynamics) pharmacokinetics (see Pharmacokinetics) pharmacology (see Pharmacology, ) receptor agonist/antagonist, safety (see Safety, ) stabilization and maintenance, transdermal delivery, 110 Buprenorphine transdermal patches (BUP TDS) adverse reactions, 119 chronic cancer and non-cancer pain, 118 elderly patients, 127 heterogenous populations, pain patients, LD-BUP TDS, long-term use, 119 nerve-injury-induced pain, 122 neuropathic pain, 115 nociceptive pain, BUP TDS. See Buprenorphine transdermal patches (BUP TDS) C Cancer pain intravenous methadone, 83, 85, 87 opioid switching, 83 PCA, 83 Cardiac action potentials (R-) and (S-) methadone isomers, cardiac arrhythmias, 54 herg K + channel, 54, 55 phases, 54 Cardiac arrhythmias, 52, 54, 58 Cardiac toxicity ECG recommendations, 5, 6 methadone toxicity, 5 Cardiovascular effects, methadone action mechanism, 52 female gender, 53 Long QT syndrome ( see Long QT syndrome) myocardial cell action potential prolongation, sudden cardiac death, 52 torsades de pointes, 53 Chronic administration, methadone heroin use histories, 61 seminal human studies, 61 treatment, pain, Chronic pain adjuvant analgesics, 2 heterogeneous pain conditions, malignant diseases, non-cancer pain conditions, special patient populations, depression, 2 management strategies, 9 methadone (see Methadone) multiple medications, 2 treatment, methadone maintenance

3 291 guidelines, 35 HIV-infected patients, 34 prevalence, 33, 34 Clinical Opiate Withdrawal Scale (COWS), Cocaine, 52, 55, 195 College on Problems of Drug Dependence (CPDD), 5 Comorbid psychopathology, MMT, 24 Conditioning pain modulation (CPM), 284 COWS. See Clinical Opiate Withdrawal Scale (COWS) CPDD. See College on Problems of Drug Dependence (CPDD) CPM. See Conditioning pain modulation (CPM) Cross tolerance, 170 opioid, 64 CYP. See Cytochrome P450 (CYP) Cytochrome P450 (CYP) antiretrovirals (see Antiretrovirals) Efavirenz, 174 in human placenta, 188 inhibitors and inducers, 189 metabolites, 172 methadone, in phase I biotransformation reactions, 185 D Death methadone, 41, 43 opioid-related overdose, 42 respiratory suppression, 43 Dehydroepiandrosterone (DHEA), 47 Detoxification, ME guidance, 234 neonatal abstinence syndrome, 234 poorer maternal outcomes, 234 pregnant women, 234 DHEA. See Dehydroepiandrosterone (DHEA) Drug Addiction Treatment Act 2000, 140 Drug drug interaction antiretrovirals, cytochrome P450 inhibitors and inducers, 189 Drug interactions with, methadone, 68 E Elderly. See also Older patients analgesic efficacy and opioid adverse effects, 280 opioid analgesics, 277 persistent pain, 277 utilization guidelines, 280 Enantiomers, 4, 18, 69, 70, 96 Equianalgesic dose automatic dose reduction, 77 calculation, 74 ratio, 75, 76 relative analgesic potency conversion, 74 table, 74, 76 Exit strategy rotation, necessity, 222 withdrawal experience, 217 H Hepatic failure, 206, 256 Heterogeneous pain conditions, cancer and non-cancer patients, crossover Phase III study, day and 3-day regimens, large-scale PMS study, 119 pain intensity ratings, 120 rescue therapy, 118 transdermal patches, 118, 119, 121 Hyperalgesia in ex-opioid addicts, glial cell activation, 96 NMDA-antagonist activity, 96 OIH (see Opioid-induced hyperalgesia (OIH)) pain patients, treatment, I Induction, -naloxone combination, 150 complicated, 153 COWS, 151 dose adjustments, 152 home inductions, 153 patient instructions, practice guidelines, 151 precipitated withdrawal, 150 Intrapartum care, methadone/, 236 Intravenous-morphine (IV-MO), 84, 85 Intravenous use, methadone adverse effects and safety issues, clinical use, perioperative use, 86 pharmacokinetic issues, IV-MO. See Intravenous-morphine (IV-MO)

4 292 J Jadad scale, 112 L LD-BUP TDS. See Low dose matrix patch (LD-BUP TDS) Liver failure, 249 Long QT syndrome hydrochlorothiazide and ciprofloxacin, 56 QT interval prolongation, 56, 57 torsades de pointes, 56, 57 Low dose matrix patch (LD-BUP TDS), M Maintenance therapy, barriers/opportunities, 143 breastfeeding, 233 clinical considerations, 234 dosing, 234 Drug Addiction Treatment Act 2000, 140 fetal and neonatal effects, 233 induction (see Induction, ) long-term effects, 233 management, patient (see Patient, management) MSW, 154 obtaining waiver, 142 patient assessment/selection cautions, treatment, 149 elements, substance-abuse assessment, 148, 149 screening instruments, 147 pharmacological properties, 233 prescribing and storing, 142 qualifications, waiver, 140, 141 recordkeeping, stabilization and maintenance, sublingual tablet, 233 training, MAOIs. See Monoamine oxidase inhibitors (MAOIs) ME. See Methadone (ME) MEDD. See Morphine equivalent daily dose (MEDD) Medically supervised withdrawal (MSW), 154 Medication assisted treatment, 143 Metabolism pathways, humans, 183, 184 CYP 3A4, 68 69, 172, 174 CYP enzymes, 67 CYP isozymes, 185 description, 183 drug drug interactions, drug interactions, methadone, 68 first-pass metabolism, 183 hepatic/renal insufficiency, 185, 187 human liver microsome studies, 69 nor- (see Nor-) pathways, enzymatic transformations, 172, 174 phase I and II type reaction, pregnancy and breastfeeding, 188 renal excretion, 66 subcutaneous, oral and sublingual administration, Methadone (ME). See also Methadone maintenance treatment (MMT) acute pharmacodynamic actions, cardiovascular effects (see Cardiovascular effects, methadone) characteristics, opioid rotation cross-tolerance, 75 equianalgesic dose ratios, 76 MS:ME ratios, neuroactive metabolites, 75 relative potency, 75 chronic administration (see Chronic administration, methadone) deaths and ED visits, 4 5 description, 51, 59 detoxification, 234 exit strategy, 9 10 HIV-infected patients, 34 hyperalgesia (see Hyperalgesia) metabolism and excretion, missing doses, clinic, 8 older patients (see Older patients, ME) opioid maintenance treatment, opioid rotation, 7 palliative care (see Palliative care, ME) pharmacokinetics characteristics, safe prescribing, 2 properties, prescription, after imprisonment, 8 QTc prolongation and TdP, 5 6 racemic, 4 safety and QTc interval duration, 2 3 SCD advantages and disadvantages, application, 271 management, special patient populations, 69 70

5 293 successful prescription, synthesis, 59 Methadone analgesia dosing, 33 duration of action, 32, 41 peak effect, 42 relapse, illicit opioid use, 32 respiratory/cns depression, 32 therapy initiation, 62 Methadone maintenance treatment (MMT) addiction, 15 admission history and physical exam, admission, OTP, 16 associated medical problems, 25 breastfeeding, 231 chronic and acute pain, 25 comorbid polysubstance use, 24 comorbid psychopathology, 24 detoxification and discharge, dose adjustments during pregnancy, 232 dose splitting during pregnancy, 232 dosing, 232 drug interactions, methadone, fetal and neonatal effects, 231 heroin and prescription, 231 long-term effects, methadone dose determination, 18 ongoing care, 23 4 optimal dosing, pregnancy, 27 prolonged QTc and ECG screening, 23 side effects, 22 split dosing, take-home privileges, tolerance, toxicology screening, 26 Methadone Maintenance Treatment Programs (MMTPs) clinics, 8 methadone, 6 Methadone-related respiratory depression, Methadone safety acute pain treatment, 33 chronic pain treatment, pain and opioid dependence, Methadone side effects adverse effects, 39 constipation, discontinuation and re-initiation, 6 displacement, substrates, 2 endocrine effects, inappropriate dosage, 8 opioid dependence, 31 primary risk, 39 respiratory depression, sedation, 44 sleep-disordered breathing, 39, Methylnaltrexone, 40 MMT. See Methadone maintenance treatment (MMT) MMTPs. See Methadone Maintenance Treatment Programs (MMTPs) Monoamine oxidase inhibitors (MAOIs), 194 Morphine equivalent daily dose (MEDD), 254 initial morphine to methadone conversion ratios, 246, 247 MSW. See Medically supervised withdrawal (MSW) Mu opioids, acute doses, dose response relationship, 165 as partial opioid agonist, 163 receptor theory, 168 N Naloxone description, 144 Suboxone, 144 NAS. See Neonatal abstinence syndrome (NAS) Neonatal abstinence syndrome (NAS) methadone/ exposure, 235 non-pharmacological care, 235 opioids in utero, 235 pharmacological care, 235 symptoms and signs, 235 Neuropathic pain analgesics, 125 BUP-TDS, 115, 122 κ 3 -opioid receptor antagonist, 111 nonmalignant, 121 NMDA receptors. See N-methyl-D-aspartate (NMDA) receptors N -methyl-d-aspartate (NMDA) receptors, , 245, 268 NNRTIs. See Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Nociceptive pain, BUP-TDS efficacy, , 122 Non-cancer pain conditions, BUP TDS, central neuropathic pain, 122

6 294 Non-cancer pain conditions, (cont.) LD-BUP TDS, nerve-injury-induced pain, 122 tramadol, 121, 123 VAS pain scores, 121, 122 Non-nucleoside reverse transcriptase inhibitors (NNRTIs), 190 Non-opioid analgesics, 9 Nor- affinity, 185 CYP isozymes, 185 in feces, 184 in human placenta, 188 metabolic pathways, plasma concentration, 184 in renal impairment, 187 urinary excretion, NRTIs. See Nucleoside reverse transcriptase inhibitors (NRTIs) Nucleoside reverse transcriptase inhibitors (NRTIs), O OAT. See Opioid agonist treatment (OAT) Office-based maintenance addiction treatment, 143 barriers, 143, retention rates, 139 clinical guidelines, 151 Drug Addiction Treatment Act 2000, 140 recordkeeping, reimbursement, 158 REMS, 147 training program, Office based opioid treatment (OBOT). See Office-based maintenance OIC. See Opioid-induced constipation (OIC) OIH. See Opioid-induced hyperalgesia (OIH) OIN. See Opioid-induced neurotoxicity (OIN) Older patients analgesia (see Analgesia) advantages and disadvantages, 285 clinical trials, 284, 285 CPM, 284 elimination, 283 lipophilicity, 283 low-dose transdermal patches, 284 metabolism, 283 middle-age group, 285 morphine and fentanyl possession, 284 pharmacokinetics and pharmacodynamics, 282 sedation and cognitive impairment, 284 transdermal absorption, 283 ME advantages and disadvantages, 282, 283 American Geriatrics Society guidelines, 282 cardiac toxicity, 282 chronic renal failure, 281 concomitant medications, CYP2D6 hepatic enzyme inhibitors, 282 half-life and pharmacokinetics, 281 lipophilic drug, 281 liver, 281 pharmacokinetics and pharmacodynamics properties, 281 protein, 281 QTc interval, 282 methadone (see Methadone) opioids, 280 Opioid agonist treatment (OAT) methadone/, 230 during pregnancy, 231 Opioid analgesics, oral administration, 110 Opioid blockade, Opioid dependence blockade/cross-tolerance, , 164 human laboratory studies, inpatient subjects, 64 methadone, 15, 20, 62, 63 methadone dosing, 168 methadone maintenance, 139 MMT (see Methadone maintenance treatment (MMT)) naloxone combination, pain, methadone maintenance ( see Pain, methadone maintenance) pharmacodynamic properties, physical dependence, 170 probuphine, 145 recordkeeping, reimbursement, 158 R isomer, methadone, 21 Opioid-dependent pregnant women maintenance treatment ( see Maintenance therapy, ) comprehensive care, heroin and prescription, 229 intrapartum and postpartum care, 236 management, methadone detoxification ( see Methadone) misuse, 229

7 295 MMT (see Methadone maintenance treatment (MMT)) NAS (see Neonatal abstinence syndrome (NAS)) nonmedical users, 229 risks and benefits, treatment, screening and assessment, Opioid-induced constipation (OIC) description, 40 methylnaltrexone, 40 tolerance, 40 Opioid-induced hyperalgesia (OIH) mu-opioid receptor activation, 92 neurophysiologic mechanisms, withdrawal and tolerance, Opioid-induced neurotoxicity (OIN), 245 Opioid-like-1 (ORL-1) receptor, 250 Opioid maintenance treatment, methadone, See also Methadone maintenance treatment (MMT) Opioid pharmacology. See Pharmacology, Opioid receptor agonist/antagonist K +-channel openers, nociceptin/orphanin FQ receptors, 112 κ 3 -opioid receptor antagonist, 111 Opioid rotations μ activity, 219 anticipated acute pain, definition and principle, description, 215 drug abuse and diversion, exit strategies, full mu agonists, h Opioid Free, 216 injectable form, 216 mechanics, methadone involved automatic dose reduction, 77 dose adjustment, 77, 78 equianalgesic dose tables, 76 guidelines, 76, 77 pain and addiction, 225 precipitated withdrawal, therapeutic and pharmacologic intervention, treatment, unanticipated acute pain, 219 withdrawal, vs. methadone, 217 Opioids. See also Methadone; Opioid dependence abstinence signs and symptoms, 61 analgesia, 2 conversions, 62 diversion, 10 long-term, 47 maintenance treatment, pharmacodynamics (see Pharmacodynamics, opioid maintenance treatment) mu opioid agonists, 60 mu opioid receptors, 4 older patients analgesic efficacy and adverse effects, 280 guidelines, 280 opioid-tolerant individuals, 60 overdose, 60 prescription, reassessment, 10, 11 R-enantiomer, 69 rotation, 7 SCD, pharmacokinetics and pharmacodynamics, substitution therapy, 8 successful prescription, 11 switching (see Switching, opioids) tolerability, tolerance, withdrawal, withdrawal syndrome, 62 Opioid side effects. See also Methadone side effects abuse and addiction, adrenal insufficiency, 47 cardiac, 205 CNS depression, 205 gastrointestinal, guidelines, prescribing, 44 immune and endocrine, 206 OIC (see Opioid-induced constipation (OIC)) overdose and tolerance, 203 psychiatric, respiratory depression, 41 44, sedation, 44 skin, 205 sleep-disordered breathing, Opioid treatment programs (OTP) admission to MMT, 16 ongoing care, 23 Optimal dosing, ME anxiety, 21 conditioned cravings/ tiggers, 19 cravings, 19 incremental dose increases, 20 insomnia, 21 relapse, 20

8 296 ORL-1 receptor. See Opioid-like-1 (ORL-1) receptor OTP. See Opioid treatment programs (OTP) Overdose, opioid therapy, 42 Oxford quality scoring system, 112 P Pain abdominal, 40 and addiction, 225 anticipated acute pain, and chemical dependency, methadone maintenance, chronic, 282 chronic noncancer pain, 40, 47 CPM, 284 descending pain facilitatory mechanism, dosing schedule, 220 exit strategy, guidelines, initiating methadone, 42, 45 hydrocodone/oxycodone compound analgesics, 214 increased sensitivity, opioid withdrawal, 95 inflammatory origin, 93 intolerance, opioid, 92 management, 214 methadone maintenance acute pain, 33 chronic pain, CNS depression, 32 misconceptions, 31 opioid analgesics, 32 moderate-to-severe, 39 nonmalignant, 47 opioid-related overdose, 42 opioid responsive pain, 214 and palliative care ( see Palliative care, pain) persistent and acute, 277 pharmacologic intervention, 218 SCD (see Sickle cell disease (SCD), pain) tolerance in humans, 94 unanticipated acute pain, 219 unsustainable improvement, 215 Pain management analgesic efficacy, pharmacological profile, switching, TDS and BTP, 254 methadone pharmacokinetics analgesic effects, 244 clinical research, 245 CYP450 isoenzymes, 244 half-life contributes, 243 NMDA activation, 245 OIN, 245 RCTs, 245 opioid rotation incomplete cross tolerance, 73 relative-potency trials, 74 Palliative care ME clinical uses, 245 dosing, 249 formulations, 245 pain management (see Pain management) patient (see Patient, ME) pharmacological profile (see Pharmacology) potential benefits and problems, 242 unique and complex pharmacology, 242 pain (see Buprenorphine, pain) CNS side effects, 241 methadone (see Palliative care, ME) mu-opioid receptor, 241 opioids, 241, 242 potent analgesic effects, vulnerable patients, 241 Partial agonist mu agonist, 165 opioid-like receptor-1 (ORL-1), 163 Patient age considerations, 256 hepatic failure, 256 renal failure, management adherence and retention, coordination, care/role, 155 ending maintenance treatment, 155 reimbursement, 158 special populations, working with pharmacies, 156 ME age considerations, 249 BTP, clinicians, 246 initial morphine to methadone conversion ratios, 246 liver failure, 249 MEDD, 247 median pre-switch dose, 248

9 297 opioid naïve patients, 248 oral conversion ratio, 249 palliative care, 248 pre-switch morphine doses, 247 renal failure, 249 rotation schedule, 246, 247 single opioid doses, non-tolerant patients, 246 titration strategies, 246 wash-out period, Patient-controlled analgesia (PCA), 83 PCA. See Patient-controlled analgesia (PCA) Perioperative use, IV-ME, 86 Peripherally active opioid antagonists, 40 Pharmacodynamics acute and chronic administration dissociation, 167 dose-dependent physiological effects, misuse and diversion, 166 mu agonist, 165 opioid withdrawal, sublingual formulations, analgesia, 167 opioid dependence, opioid maintenance treatment, Pharmacokinetics absorption, 171 distribution, 172, 173 excretion, 175 intravenous methadone bioexponential l decline, 81 double-blind trial, long-term treatments, 82 metabolism, 172, methadone and absorption, 278 distribution, metabolism, 279 methadone and transdermal, 277, 278 renal excretion, 279 properties, methadone, Pharmacology application, delta-receptor antagonist and ORL-1, 250 half-life, sublingual, 251 humans, 251 kappa opioid receptor, 144 mu-and kappa-receptors, 250 naloxone, 144 parent compound and nor, 251 partial agonistic activity, populations of patients, preclinical studies, 251 side effects (see Opioid side effects) tolerability, changes pharmacodynamic, 279 pharmacokinetic (see Pharmacokinetics) hydrocodone/oxycodone compound analgesics, 214 management, 214 ME hepatic metabolism, 243 highly lipophilic, 243 interindividual variations, 243 NMDA receptor blockage effects, 243 phase half-lives, 243 opioid debt, partial μ agonist medications, 214 patient care, 214 PIs. See Protease inhibitors (PIs) Polysubstance use, 24 Postoperative pain, 86 Postpartum care, methadone/, 236 Pregnancy MMT, 27 opioid dependence (see Opioid-dependent pregnant women) Prescribing, methadone. See Methadone, SCD Protease inhibitors (PIs) description, and NRTIs, 190 R Racemic methadone, 4 Randomized controlled trials (RCTs), 245, 252, 253 RCTs. See Randomized controlled trials (RCTs) Relapse prevention theories, 32 Relative potency description, 74 equianalgesic table construction, 74 ME and opioid dose, 75 opioid rotation, 75 single-dose, 75 REMS. See Risk Evaluation and Mitigation Strategy (REMS)

10 298 Renal failure, methadone, 249 Rifampin, Risk Evaluation and Mitigation Strategy (REMS), 147 Rotation, opioid. See Opioid rotations S Safety, abuse potential and diversion, accidental ingestion and overdose, 146 adverse reactions and contraindications, 145 ceiling effect, respiratory function, dose response relationship, 128 drug-drug interactions, effective pain management, 130 FEN TDS and BUP TDS, preemptive treatment, skin, 132 randomized trials, 128 site-specific adverse effects, skin burns, 131 transdermal opioids, 129 SCD. See Sickle cell disease (SCD) Sedation, 44 Sickle cell disease (SCD) methadone (see Methadone, SCD) opioids, pain acute to chronic pain, 265 APS staff, 264 behavior and bilateral mistrust, 265 iceberg, 263 neuropathic, nociceptive, 264 opioid management, 265 patients, 265 pseudoaddiction, 265 syndromes, 264 vs. usual cancer pain, 264 VOC, 263 Sleep-disordered breathing polysomnography, 45 risk stratification and management procedure, 45, 46 therapeutic options, 45 Split dosing, methadone, Sublingual rescue analgesia, 118 rescue therapy, 118 Substance abuse non-opioid drugs, 25 take-home medications, 26 Switching, opioids cancer pain, 83 opioid-induced hyperalgesia, 84 titration, IV-ME, 85 T Take-home medications, TdP. See Torsades de Pointes (TdP) Torsades de Pointes (TdP) drugs associated, 3 methadone induced QTc prolongation, 5 6 Toxicity CYP inhibitors, 43 methadone, 42 Transdermal, therapeutic efficacy, 110 BUP TDS (see Buprenorphine transdermal patches (BUP TDS)) fentanyl transdermal patch (FEN TDS), 119 Transdermal system (TDS) formulation analgesic efficacy, BTP, 254, 250 switching, and opioids, U UDP-glucuronosyltransferase (UGT) enzymes, 183, 207 V Vaso-occlusive crisis (VOC), 263, 264 VOC. See Vaso-occlusive crisis (VOC)