Page 45 - CPG - Clinical Practice Guidelines - Management of Cancer Pain
P. 45

Management of Cancer Pain (Second Edition)
                  However, no quality assessment of primary studies was mentioned.

                  :+2 JXLGHOLQHV VWDWH WKDW GXH WR WKH FRPSOH[ QDWXUH DQG ZLGH LQWHU
                  individual variation in  its  pharmacokinetics,  methadone should be
                  LQLWLDWHG RQO\ E\ SUDFWLWLRQHUV H[SHULHQFHG LQ FDQFHU SDLQ  11

                  5HFRPPHQGDWLRQ
                  •  Methadone may be considered in the management of cancer pain
                    {  ,W VKRXOG RQO\ EH SUHVFULEHG E\ KHDOWKFDUH SURYLGHUV H[SHULHQFHG ZLWK
                      its use in the management of cancer pain.


                  ‡   3HWKLGLQH
                  Pethidine should  not  be  used in  chronic cancer pain management.
                  /RQJ WHUP SHWKLGLQH XVH RU DW KLJK GRVHV SRVH D ULVN RI WR[LF PHWDEROLWH
                  (norpethidine) accumulation and can cause seizures. Its use may have
                  an increased risk of addiction and is associated with higher incidence
                  of euphoria. 9


                  5HFRPPHQGDWLRQ
                  •  Pethidine should not be used in the management of cancer pain.


                         2SLRLGV XVH LQ VSHFLDO SRSXODWLRQV
                  ‡   5HQDO DQG OLYHU LPSDLUPHQW
                  Renal and liver  impairment alter the pharmacokinetics  of many
                  medications including opioids by  changing opioid metabolism
                  and reducing its  clearance, resulting in accumulation of  the  opioid
                  metabolites. These generally result in more AEs and an increased risk
                  RI WR[LFLW\  7KHUH LV OLPLWHG HYLGHQFH H[DPLQLQJ WKH XVH RI RSLRLGV LQ
                  cancer patients with renal and liver impairment.

                  The use of opioids in cancer patients with renal impairment is based
                  RQ  SKDUPDFRNLQHWLF  GDWD   H[WUDSRODWLRQ  RI  HYLGHQFH  LQ  QRQ FDQFHU
                  SDWLHQWV DQG FOLQLFDO H[SHULHQFH  &OLQLFDO HYLGHQFH RQ WKH XVH RI RSLRLGV
                  in cancer patients with renal impairment was scarce and of very low
                  quality. 39, level I;  51,  level I   *LYHQ  WKH  ODFN  RI  UHOHYDQW  FOLQLFDO  GDWD   WKH
                  VWUDWL¿FDWLRQ RI ULVN LV JXLGHG E\ WKH DFWLYLW\ RI LWV PHWDEROLWHV DQG LWV
                  potential to accumulate.

                  0RUSKLQH LV PHWDEROLVHG LQ WKH OLYHU WR PRUSKLQH   JOXFXURQLGH  0 *
                  DQG  PRUSKLQH   JOXFXURQLGH   0 *    %RWK  DUH  H[FUHWHG  LQ  WKH  XULQH
                  0 * LV DQ LQDFWLYH PHWDEROLWH  ZKLOH 0 * LV DFWLYH DQG ERWK DFFXPXODWH
                  LQ UHQDO LPSDLUPHQW  $FFXPXODWLRQ RI 0 * LV DVVRFLDWHG ZLWK FHQWUDO
                                                         9
                  nervous system AEs and respiratory depression.


                                             27




          e-cpg inside text-Cancer pain-25/5/24.indd   27               09/08/2024   12:09 AM
   40   41   42   43   44   45   46   47   48   49   50