Oral morphine drops for prompt relief of breathlessness in patients with advanced cancer—a randomized, double blinded, crossover trial of morphine sulfate oral drops vs. morphine hydrochloride drops with ethanol (red morphine drops)
| Autor: | Birte Hedal, Birgit Aabom, Poul Lunau Christensen, Gunnar Hellmund Laier, May-Britt Jensen, Tine Karlsson |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Double blinded Administration Oral Sublingual administration 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Double-Blind Method Neoplasms medicine Clinical endpoint Humans 030212 general & internal medicine Aged Aged 80 and over Cross-Over Studies Ethanol Morphine business.industry Middle Aged Crossover study Clinical trial Dyspnea Oncology Opioid chemistry 030220 oncology & carcinogenesis Anesthesia Female business medicine.drug |
| Zdroj: | Supportive Care in Cancer. 28:3421-3428 |
| ISSN: | 1433-7339 0941-4355 |
| DOI: | 10.1007/s00520-019-05116-1 |
| Popis: | Episodic breathlessness is frequent in palliative cancer patients. Opioids are the only pharmacological agents with sufficient evidence in treatment. In Denmark, the main recommendation is red morphine drops (RMD), an off-label solution of morphine, ethanol, and red color (cochenille) described since 1893 (Pharmacopoea Danica). In 2015, the Danish Medicines Agency increased focus on off-label medicines and recommended registered morphine drops without ethanol instead. However, our palliative patients told us that RMD was better. For that reason, we conducted a clinical trial to clarify any perceived difference between the two types of drops. We conducted a randomized, double blinded, crossover trial. Patients were asked to perform standardized activity (2-min walk) aiming to provoke breathlessness. Primary endpoint (breathlessness NRS) and secondary endpoints (saturation, pulse, respiratory frequency) were measured before (t = 0) and after test medicine at t = 1, t = 3, t = 5, t = 10, and t = 20 min. After 2–4 days (washout period), the patients repeated the test, receiving the alternative drops in a blinded setup (crossover). In the first 3 min, the relative drop in breathlessness for morphine drops with ethanol (RMD) was significant more than for morphine drops without ethanol. We found no significant difference in secondary endpoints. A conclusion could be that ethanol might facilitate morphine absorption in the mouth. Our results needs further research of opioid absorption in the mouth as well as trials, testing morphine vs. more lipophilic opioids. The RMD drops are cheap, easy to use, and noninvasive and keep the patient independent of health care professionals. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink