• Paul Glue, Gavin Cape, Donna Tunnicliff, Michelle Lockhart, Fred Lam, Andrew Gray, Noelyn Hung, C Tak Hung, Sarah Harland, Jane Devane, John Howes, Holger Weis, and Lawrence Friedhoff.
• University of Otago, Dunedin, New Zealand.
• J Clin Pharmacol. 2016 Aug 1; 56 (8): 960-5.

AbstractThe aim of this study was to switch patients established on methadone opioid substitution therapy (OST) to morphine over 1 week. Subjects established on daily methadone OST (mean dose 60 mg/day) were switched to morphine slow-release capsules, dosed at 4× the previous total daily methadone dose, for 6 days, then given morphine syrup dosed q3h. All 27 subjects enrolled in this study completed the switch from methadone to morphine. Opioid withdrawal symptoms (OWS) peaked within 12-24 hours of starting morphine, and 24/27 subjects required higher daily morphine doses (mean 5.2× multiple). Pharmacokinetic evaluation showed that 91% of methadone was cleared during this time, with a mean elimination half-life of 59 hours. The most frequent treatment-emergent non-OWS adverse events were headache, nausea, constipation, and neck pain. The method described here appears to be a safe and acceptable approach to switch subjects from methadone to morphine.© 2016, The American College of Clinical Pharmacology.

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