Palliative care has different goals than curative care, particularly for hospice patients nearing the end of life. It can be difficult to find pharmacological guidance for the conditions and comorbidities encountered in hospice. Enclara Pharmacia’s Palliative Pearls series helps fill the gap. Inspired by real life clinical consultations between hospice clinicians and Enclara pharmacists, these clinical case studies and reviews are provided as a service to the entire hospice community.
For decades, the synthetic opioid buprenorphine has been primarily used in the treatment of opioid use disorder (OUD) rather than pain management. Today, however, regulatory changes making it easier to prescribe buprenorphine have spurred renewed interest in the drug among palliative care practitioners.
This month’s case takes a deeper dive into methadone dosing, going beyond the basics to review the use of methadone “as needed,” for analgesia in patients with opioid dependence and as an adjuvant analgesic. For a review of dosing basics, refer to the prior cases: Methadone Conversion: Revisiting a Prior Case and Methadone and the Pediatric Patient: Dosing Guidance.
Serotonin toxicity, also known as serotonin syndrome, is a potentially life-threatening condition that can occur when there is an excessive amount of the neurotransmitter, serotonin, in the body. Enclara Pharmacia has prepared a printable chart, Medications Impacting Serotonin, to accompany this introduction to an often-overlooked contributor to mental status changes, neuromuscular and autonomic hyperactivity and even coma or death.