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This multicenter trial examined the efficacy and safety of dextromethorphan
(DM) as an enhancer of analgesia and modulator of opioid tolerance in cancer
patients with pain. Sixty-five eligible patients were randomized to slow-release
morphine plus DM or slow-release morphine plus placebo. The initial DM dose
was 60 mg four times daily for seven days, with an increase to 120 mg four times
daily, if tolerated, for another seven days. During the study, patients recorded
medications and scores for pain, nausea, drowsiness, and insomnia.
The differences in average pain scores, number of breakthrough doses, and change
in total morphine consumption between the DM group and the placebo group were
not statistically significant. Side-effect scores were not statistically significantly
different. Dizziness was greater in the DM (58%) than placebo (36%) group. This
study showed a statistically nonsignificant enhancement of analgesia or modulation
of opioid tolerance in cancer patients with pain when DM was added to morphine.
Participants receiving the DM also had more toxicity, particularly dizziness.
This toxicity and the limited evidence of effect do not support the use of DM
to enhance opioid analgesia or to modulate opioid tolerance in cancer patients.
Dudgeon DJ, Bruera E, Gagnon B, Watanabe SM, Allan SJ, Warr DG, MacDonald SM,
Savage C, Tu D, Pater JL. From J
Pain Symptom Manage. J Pain Symptom Manage. 2007 Apr;33(4):365-71.
PMID 17397698
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed
Credit: PubMed, developed by the National Center for Biotechnology Information
(NCBI) at the
National Library of Medicine (NLM).
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