Effectiveness of the Buccal Mucosa Route for Methadone Administration at the End of Life
Journal of Palliative Medicine
Author information
Donna Spaner, MD1,2
1Palliative Care Unit, Toronto Grace Health Centre, Toronto, Ontario, Canada.
2Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Accepted April 8, 2014
ABSTRACT
Background:
Methadone is a useful analgesic for neuropathic and nociceptive pain.
However, there is little information about the use of methadone in the
final days of life when a patient cannot swallow, discouraging its use
by many palliative care physicians.
Objective: The
purpose of this study was to investigate the effectiveness of switching
patients on oral methadone at the end of life to methadone by the buccal
mucosa route.
Methods: This is a case series
comprising 36 patients on the Toronto Grace Palliative Care Unit (PCU)
who took methadone between 2010 and 2012. Their health records were
retrospectively reviewed. When patients could no longer swallow at the
end of life, oral methadone was replaced with methadone solution in a
concentration of 10 mg/mL, placed in the space between the buccal mucosa
and lower molars.
Results: Twenty-five patients
met inclusion criteria for the series. Twenty-four (96%) of the patients
tolerated methadone by the buccal route and were able to continue
receiving it that way until they died. Methadone was discontinued by the
buccal route in one case (4%) because of intolerance to having
medication placed in the oral cavity. Of the patients who remained on
buccal methadone, there was a need to increase the dose in two patients
with the remaining patients taking the same dose of buccal methadone
until they died.
Conclusion: The cases
reviewed suggest that methadone is well tolerated and effective when
switched to the buccal route in patients at the end of life on a
palliative care unit.
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