VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

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DRAFT 3 - DO NOT DISTRIBUTE VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain 204. Inturrisi CE, Verebely K. Disposition of methadone in man after a single oral dose. Clin Pharmacol Ther. Nov-Dec 1972;13(6):923-930. 205. Wolff K, Rostami-Hodjegan A, Hay AW, Raistrick D, Tucker G. Population-based pharmacokinetic approach for methadone monitoring of opiate addicts: Potential clinical utility. Addiction. Dec 2000;95(12):1771-1783. 206. de Vos JW, Geerlings PJ, van den Brink W, Ufkes JG, van Wilgenburg H. Pharmacokinetics of methadone and its primary metabolite in 20 opiate addicts. Eur J Clin Pharmacol. 1995;48(5):361- 366. 207. Wolff K, Hay AW, Raistrick D, Calvert R. Steady-state pharmacokinetics of methadone in opioid addicts. Eur J Clin Pharmacol. 1993;44(2):189-194. 208. Anggard E, Nilsson MI, Holmstrand J, Gunne LM. Pharmacokinetics of methadone during maintenance therapy: Pulse labeling with deuterated methadone in the steady state. Eur J Clin Pharmacol. Aug 1979;16(1):53-57. 209. Nilsson MI, Anggard E, Holmstrand J, Gunne LM. Pharmacokinetics of methadone during maintenance treatment: Adaptive changes during the induction phase. Eur J Clin Pharmacol. 1982;22(4):343-349. 210. Inturrisi CE, Colburn WA, Kaiko RF, Houde RW, Foley KM. Pharmacokinetics and pharmacodynamics of methadone in patients with chronic pain. Clin Pharmacol Ther. Apr 1987;41(4):392-401. 211. Gourlay GK, Cherry DA, Cousins MJ. A comparative study of the efficacy and pharmacokinetics of oral methadone and morphine in the treatment of severe pain in patients with cancer. Pain. Jun 1986;25(3):297-312. 212. Plummer JL, Gourlay GK, Cherry DA, Cousins MJ. Estimation of methadone clearance: Application in the management of cancer pain. Pain. Jun 1988;33(3):313-322. 213. Denson DD, Concilus RR, Warden G, Raj PP. Pharmacokinetics of continuous intravenous infusion of methadone in the early post-burn period. J Clin Pharmacol. Jan 1990;30(1):70-75. 214. Nilsson MI, Gronbladh L, Widerlov E, Anggard E. Pharmacokinetics of methadone in methadone maintenance treatment: Characterization of therapeutic failures. Eur J Clin Pharmacol. 1983;25(4):497-501. 215. Grochow L, Sheidler V, Grossman S, Green L, Enterline J. Does intravenous methadone provide longer lasting analgesia than intravenous morphine? A randomized, double-blind study. Pain. Aug 1989;38(2):151-157. 216. Hansen J, Ginman C, Hartvig P, et al. Clinical evaluation of oral methadone in treatment of cancer pain. Acta Anaesthesiol Scand Suppl. 1982;74:124-127. 217. Sawe J, Hansen J, Ginman C, et al. Patient-controlled dose regimen of methadone for chronic cancer pain. Br Med J (Clin Res Ed). Mar 7 1981;282(6266):771-773. 218. McPherson ML. Demystifying opioid conversion calculators: A guide to effective dosing. Bethesda, MD: American Society of Health-System Pharmacists; 2009. 219. Foley KM, Houde RW. Methadone in cancer pain management: Individualize dose and titrate to effect. J Clin Oncol. Oct 1998;16(10):3213-3215. 220. Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F. Switching from morphine to oral methadone in treating cancer pain: What is the equianalgesic dose ratio? J Clin Oncol. Oct 1998;16(10):3216-3221. 221. Lawlor PG, Turner KS, Hanson J, Bruera ED. Dose ratio between morphine and methadone in patients with cancer pain: A retrospective study. Cancer. Mar 15 1998;82(6):1167-1173. 222. Bruera E, Pereira J, Watanabe S, Belzile M, Kuehn N, Hanson J. Opioid rotation in patients with cancer pain. A retrospective comparison of dose ratios between methadone, hydromorphone, and morphine. Cancer. Aug 15 1996;78(4):852-857. February 2017 Page 190 of 192
DRAFT 3 - DO NOT DISTRIBUTE VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain 223. Ayonrinde OT, Bridge DT. The rediscovery of methadone for cancer pain management. Med J Aust. Nov 20 2000;173(10):536-540. 224. Morley JS, Makin MK. Comments on ripamonti et al., pain, 70 (1997) 109-115. Pain. Oct 1997;73(1):114-115. 225. Hanks GW, Conno F, Cherny N, et al. Morphine and alternative opioids in cancer pain: The EAPC recommendations. Br J Cancer. Mar 2 2001;84(5):587-593. 226. Symonds P. Methadone and the elderly. Br Med J. Feb 19 1977;1(6059):512. 227. Bruera E, Watanabe S, Fainsinger RL, Spachynski K, Suarez-Almazor M, Inturrisi C. Custom-made capsules and suppositories of methadone for patients on high-dose opioids for cancer pain. Pain. Aug 1995;62(2):141-146. 228. Ettinger DS, Vitale PJ, Trump DL. Important clinical pharmacologic considerations in the use of methadone in cancer patients. Cancer Treat Rep. Mar 1979;63(3):457-459. 229. VA/DoD Evidence-Based Clinical Practice Guideline Work Group, Department of Veterans Affairs, Department of Defense, Office of Quality and Performance. Management of opioid therapy for chronic pain. 2010; http://www.healthquality.va.gov/. 230. Kharasch ED, Hoffer C, Whittington D, Sheffels P. Role of hepatic and intestinal cytochrome P450 3A and 2B6 in the metabolism, disposition, and miotic effects of methadone. Clin Pharmacol Ther. Sep 2004;76(3):250-269. 231. Kharasch ED, Bedynek PS, Park S, Whittington D, Walker A, Hoffer C. Mechanism of ritonavir changes in methadone pharmacokinetics and pharmacodynamics: I. Evidence against CYP3A mediation of methadone clearance. Clin Pharmacol Ther. Oct 2008;84(4):497-505. 232. Kharasch ED, Bedynek PS, Walker A, Whittington D, Hoffer C. Mechanism of ritonavir changes in methadone pharmacokinetics and pharmacodynamics: Ii. Ritonavir effects on CYP3A and P- glycoprotein activities. Clin Pharmacol Ther. Oct 2008;84(4):506-512. 233. Totah RA, Sheffels P, Roberts T, Whittington D, Thummel K, Kharasch ED. Role of CYP2B6 in stereoselective human methadone metabolism. Anesthesiology. Mar 2008;108(3):363-374. 234. Kharasch ED, Hoffer C, Whittington D, Walker A, Bedynek PS. Methadone pharmacokinetics are independent of cytochrome P4503A (CYP3A) activity and gastrointestinal drug transport: Insights from methadone interactions with ritonavir/indinavir. Anesthesiology. Mar 2009;110(3):660-672. 235. Kharasch ED, Walker A, Whittington D, Hoffer C, Bedynek PS. Methadone metabolism and clearance are induced by nelfinavir despite inhibition of cytochrome P4503A (CYP3A) activity. Drug Alcohol Depend. May 1 2009;101(3):158-168. 236. Kharasch ED, Stubbert K. Role of cytochrome P4502B6 in methadone metabolism and clearance. J Clin Pharmacol. Mar 2013;53(3):305-313. 237. CYP2B6. Allele nomenclature. 2013; http://www.cypalleles.ki.se/cyp2b6.htm. Accessed January 28, 2016. 238. Morley J, Makin M. The use of methadone in cancer pain poorly responsive to other opioids. Pain Rev. 1998;5:51-58. 239. Zimmermann C, Seccareccia D, Booth CM, Cottrell W. Rotation to methadone after opioid dose escalation: How should individualization of dosing occur? J Pain Palliat Care Pharmacother. 2005;19(2):25-31. 240. Mercadante S, Casuccio A, Fulfaro F, et al. Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: A prospective study. J Clin Oncol. Jun 1 2001;19(11):2898-2904. 241. CPSO Task Force on CNMP. Evidence-based recommendations for medical management of chronic non-malignant pain: College of Physicians and Surgeons of Ontario (CPSO) 2000. 242. Wong E, Walker KA. A review of common methods to convert morphine to methadone. J Community Hosp Intern Med Perspect. 2012;2(4). February 2017 Page 191 of 192
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Appendix D: Drug Tables A. Short-ac
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Short-Acting Opioid Initial Oral Do
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Short-Acting Opioid Tramadol (alone
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Long-Acting/ER Opioids 1 Buprenorph
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Long-Acting/ER Opioids 1 Hydrocodon
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Long-Acting/ER Opioids 1 Initial Do
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3 CYP-3A4 inhibiting agents include
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VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

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