ABSTRACT
The guide to proper use of methadone in Japan describes the SAG method (a method of stopping all leading opioids and starting methadone). Based on strict evaluation, our palliative care department introduces methadone by adding to the preceding opioid, and then tapering or discontinuation the preceding opioid. This time, we considered the clinical significance of 28 patients who received this method. In 20 of 28 cases (71.4%), methadone reached the maximum dose, and methadone titration could be safely performed without exacerbation of pain or serious adverse events. However, in order for this method to be performed safely, it is necessary to pay attention to the pharmacological properties of methadone, which has a long half-life, and to make a detailed evaluation and drug adjustment of the analgesic effect and adverse events after the introduction of methadone.
ABSTRACT
<b>Case 1</b>: A female, aged 81 years, with cardiac stomach cancer. Air retention in the digestive tract aggravated discomfort of the epigastric region, but belching relieved the symptom. As belching insufficiency persisted, the continuous subcutaneous injection of metoclopramide was started. Belching was promoted, and swelling of the upper abdomen was relieved. <b>Case 2</b>: A male aged 57 years. Gastrointestinal obstruction related to pancreatic head cancer was observed. He complained of discomfort of the upper abdomen with abdominal swelling. Belching reduced these symptoms. The continuous subcutaneous injection of metoclopramide facilitated belching, and relieved discomfort of the upper abdomen.<b>Discussion</b>： The results suggest that the continuous administration of metoclopramide is a useful option for belching insufficiency associated with cancer-related gastrointestinal obstruction. In the presence of gastrointestinal obstruction,gas retained in the stomach may be elevated/regurgitated through the peristalsis-promoting actions of metoclopramide,promoting belching.