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Discussion on methadone initiation protocols: A case report

Matthieu Delaye, MD, Sophie Laurent, MD, Mélanie Try, MD, Erwan Treillet, MD


Through a concrete case, we discuss the main published protocols to initiate methadone and illustrate the advantages and disadvantages of rapid or gradual initiation and on-demand or fixed doses with rescue doses. Daily doses can vary widely depending on the protocol chosen. An on-demand administration could lead to an overdose as illustrated in our case. A better understanding of particularities and limitations of these protocols could lead to safer methadone initiation. Systematic comparison of different protocols and calculation of the daily dose should be a standard in clinical practice.


methadone, opioid rotation, cancer pain, methadone initiation

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