Practicability, safety, and efficacy of a "German model" for opioid conversion to oral levo-methadone

Ostgathe C, Voltz R, Van Aaaken A, Klein C, Sabatowski R, Nauck F, Gaertner J (2012)

Publication Status: Published

Publication Type: Journal article, Original article

Publication year: 2012

Journal

Supportive Care in Cancer Springer

Publisher: Springer Verlag (Germany)

Book Volume: 20

Pages Range: 2105-2110

Journal Issue: 9

DOI: 10.1007/s00520-011-1320-8

Abstract

Introduction: An algorithm to convert from any other opioid to oral levo-methadone was developed in Germany, the German model of levo-methadone conversion (GMLC). According to this GMLC, the pre-existing opioid is stopped, then titration of oral levo-methadone is initiated with a starting dose of 5 mg orally q 4 h (plus prn q 1 h). If necessary, levomethadone dose is increased (pain) or decreased (side effects) by 30% q 4 h (plus prn q 1 h). After 72 h, the achieved single dose is maintained, but the dosing interval increases twofold to q 8 h (plus prn q 3 h). The aim of this study was to obtain information about the practicability, safety, and efficacy of the GMLC in clinical routine. Methods: A retrospective, systematic chart review of levomethadone conversions for the treatment of pain in inpatient palliative care was performed. Results: Fifty-two patients were analyzed. The dosing interval was increased correctly after 72 h as demanded by the GMLC in 60% of patients. In 85% of the patients, opioid medication with levo-methadone could be maintained until the end of the inpatient stay. In three patients (6%), levo-methadone administration had to be stopped due to side effects. No serious adverse events could be detected during opioid rotation. Pain intensity was reduced significantly (p<0.001) after conversion concerning mean (NRS 0.9; range 0-4) and maximum pain over the day (NRS 3.9; range 0-10). Conclusion: The presented study indicates that the GMLC provides a practical and reasonably safe approach to perform opioid rotation to levo-methadone in a palliative care setting. © Springer-Verlag 2011.

Authors with CRIS profile

Christoph Ostgathe Professur für Palliativmedizin Carsten Klein Department of Palliative Medicine

Involved external institutions

Universitätsklinikum Carl Gustav Carus Dresden DE Germany (DE) Universität zu Köln DE Germany (DE) Georg-August-Universität Göttingen DE Germany (DE)

How to cite

APA:

Ostgathe, C., Voltz, R., Van Aaaken, A., Klein, C., Sabatowski, R., Nauck, F., & Gaertner, J. (2012). Practicability, safety, and efficacy of a "German model" for opioid conversion to oral levo-methadone. Supportive Care in Cancer, 20(9), 2105-2110. https://doi.org/10.1007/s00520-011-1320-8

MLA:

Ostgathe, Christoph, et al. "Practicability, safety, and efficacy of a "German model" for opioid conversion to oral levo-methadone." Supportive Care in Cancer 20.9 (2012): 2105-2110.

BibTeX: Download