Inpatient Transition from Methadone to Buprenorphine–Naloxone Using a Microdosing Strategy in a Postoperative Cancer Patient: A Case Report
Min Ji Kim, H. Walker, Matthew D Clark, Akhila Reddy
Journal of Palliative Medicine April 30, 2024 DOI: 10.1089/jpm.2024.0045 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Postoperative cancer patient previously on buprenorphine–naloxone and methadone |
| Duration | One week |
| Topics | Microdosing |
| Key findings | A microdosing strategy allowed a successful transition from methadone to buprenorphine–naloxone in one week without requiring a reduction in total opioid intake. |
Abstract
Background: Buprenorphine initiation in opioid-tolerant patients usually requires decreasing the total opioid intake per day due to its potential for precipitating withdrawal. However, this strategy may not be tolerated in patients who require higher amounts of opioids, such as those with cancer pain. Case Presentation: We utilized a buprenorphine microdosing strategy for a postoperative cancer patient who was previously taking buprenorphine–naloxone for chronic noncancer pain, then initiated on methadone for uncontrolled cancer-related pain. He had a planned cancer resection in the hospital. He subsequently underwent a successful transition from methadone to buprenorphine–naloxone through microdosing in one week with close monitoring in the inpatient setting.
Conclusions: Using a microdosing strategy to transition from methadone to buprenorphine–naloxone in a span of days was achieved in this case report. More research regarding the feasibility and tolerability of microinductions is needed, especially in the setting of chronic pain or cancer-related pain.