Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study
Journal of Pain and Symptom Management,

Currow DC et al. – Ten milligrams of sustained–release oral morphine once daily is safe and effective for most people who respond.

Methods
  • In a Phase II dose increment study
  • 10mg daily of sustained–release morphine was administered, and increased in nonresponders by 10mg daily each week to a maximum of 30mg daily.
  • The participant was withdrawn if there were unacceptable side effects or no response to maximum dose.
  • If participants had a 10% improvement in dyspnea over their own baseline, they joined a long–term Phase IV effectiveness/safety study at that dose.
  • Complying with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, response and side effects are described, with demographic and clinical characteristics of responders

Results
  • 83 participants (53 males, mean age 75 years, 54% with chronic obstructive pulmonary disease) provided more than 30 patient–years of data
  • 52 participants derived ≥ 10% benefit (on average 35% improvement over baseline) giving a response rate of 62% (number needed to treat of 1.6: number needed to harm 4.6); for 70%, this dose was 10mg/24h
  • Benefit was maintained at three months for 28 (33%) people
  • Ranking of breathlessness was reduced significantly (P<0.001), but constipation increased (P<0.001) despite laxatives
  • There were no episodes of respiratory depression or hospitalizations as a result of the sustained–release morphine
  • Overall, one in three people continued to derive benefit at three months

Please login or register to follow this author.
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Family Medicine

See All >> Messages include industry-sponsored communications and special communications from MDLinx

<

Most Popular Family Medicine Articles

1 Controlling obesity with potato extract McGill University News, December 11, 2014

2 Calcium and phosphorus intake and prostate cancer risk: A 24-y follow-up study American Journal of Clinical Nutrition, November 26, 2014    Clinical Article

3 Boiled coffee consumption and the risk of prostate cancer: follow-up of 224,234 Norwegian men 20-69 years British Journal of Cancer, December 24, 2014    Clinical Article

4 The use of aspirin and the risk of mortality in patients with prostate cancer The Journal of Urology, December 8, 2014    Clinical Article

5 Influence of metformin use on PSA values, free-to-total PSA, prostate cancer incidence and grade and overall survival in a prospective screening trial (ERSPC Aarau) World Journal of Urology, November 3, 2014    Clinical Article

6 Tea consumption and leukemia risk: A meta-analysis Tumor Biology, February 12, 2014    Evidence Based Medicine    Clinical Article

7 Tai chi as an alternative and complimentary therapy for anxiety: A systematic review Journal of Evidence-Based Complementary & Alternative Medicine, December 22, 2014    Evidence Based Medicine    Review Article

8 Dairy products, calcium, and prostate cancer risk: A systematic review and meta-analysis of cohort studies American Journal of Clinical Nutrition, November 26, 2014    Clinical Article

9 Crocin, the main active saffron constituent, as an adjunctive treatment in major depressive disorder: A randomized, double-blind, placebo-controlled, pilot clinical trial Journal of Affective Disorders, December 9, 2014    Clinical Article

10 Tea consumption and the risk of five major cancers: A dose-response meta-analysis of prospective studies Full Text BMC Cancer, March 18, 2014    Free full text    Evidence Based Medicine    Review Article

11 Dietary carrot consumption and the risk of prostate cancer European Journal of Nutrition, February 17, 2014    Clinical Article

12 Coffee consumption and prostate cancer risk: An updated meta-analysis Cancer Causes and Control, March 3, 2014    Evidence Based Medicine    Clinical Article

13 Systematic review of prostate cancer risk and association with consumption of fish and fish-oils: Analysis of 495,321 participants International Journal of Clinical Practice, December 16, 2014    Clinical Article

14 Impact of the 2012 United States preventive services task force statement on prostate-specific antigen screening: Analysis of urologic and primary care practices Urology, November 17, 2014    Clinical Article

15 Role of diet in prostate cancer: the epigenetic link Oncogene, December 24, 2014    Clinical Article

16 Associations of vitamin D pathway genes with circulating 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, and prostate cancer: A nested case-control study Cancer Causes and Control, December 10, 2014    Clinical Article

17 Time to onset of clinically meaningful improvement with tadalafil 5mg once daily in the treatment of men with lower urinary tract symptoms secondary to benign prostatic hyperplasia: analysis of data pooled from four pivotal, double-blind, placebo-controlled studies The Journal of Urology, December 1, 2014    Clinical Article

18 The obesity paradox in the US population Full Text American Journal of Clinical Nutrition, May 2, 2013    Free full text    Review Article

19 Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: Outcome after long-term follow-up Psychiatry Research, December 2, 2014    Clinical Article

20 Long-term coffee consumption and risk of cardiovascular disease Circulation, February 11, 2014    Evidence Based Medicine    Review Article    Clinical Article

Indexed Journals in Family Medicine: American Family Physician, Archives of Family Med, Annals of Family Medmore

 

The Top Read Articles of 2014 are Now Available

Scouring thousands of peer-reviewed journals and popular press, Our Editors just released the Top Read Articles of the Year. See the Top Read List