Methadone continues to be an important medication for the treatment of paediatric and adult
cancer-related pain. Appropriate patient selection to ensure safe and effective treatment by a team of clinicians who appreciate and are familiar with
methadone and its unique pharmacology is crucial. Unlike
morphine and other more common
opioids,
methadone is purported to have involvement with
delta-opioid receptor and higher affinity as an
N-methyl-D-aspartate-receptor antagonist. Clinically this gives it the advantage of being effective for both nociceptive and
neuropathic pain, but also may be useful in the setting of tolerance to other
opioids.
Methadone also comes in multiple available formulations that can be administrated through a variety of routes beyond the oral route. Challenges with
methadone in treating
cancer-related pain include drug interactions specifically as it relates to new targeted
cancer therapies. Recent guidelines recommend electrocardiogram monitoring with
methadone and there is potential for additive
cardiac toxicity in the oncology setting. Appropriate dosing of
methadone for
pain management given age, organ dysfunction, and patients who are on
methadone maintenance
therapy are also key factors. This article aims to provide clinicians with evidence and clinical practice guidelines for safe and appropriate use of
methadone including indication, initiation, and monitoring given its complexity for management of
pain in the dynamic oncology setting.