Professor Guo Yanru: These Medications Must Not Be Taken "Only Half a Pill"!

Source: Sunflower Children

Author: Sunflower Children

Editor: Gao ZX

Date: December 6, 2023

For children experiencing persistent cancer pain, the first choice of pain relief medication is oral opioid sustained-release formulations. These sustained-release formulations are long-acting and potent oral opioids suitable for moderate to severe, persistent cancer pain.

Commonly used opioid sustained-release formulations include morphine sulfate sustained-release tablets and oxycodone hydrochloride sustained-release tablets. Below are the common specifications:

Morphine sulfate sustained-release tablets: 10mg/tablet, 30mg/tablet

Oxycodone hydrochloride sustained-release tablets: 10mg/tablet, 40mg/tablet (equivalent to morphine sustained-release tablets of 20mg/tablet and 80mg/tablet)

Let’s explore the precautions for using these sustained-release formulations from several aspects:

Must be taken whole!

Many parents worry that their child is too young to swallow a whole pill or believe that their child’s symptoms are not severe enough, prompting them to break the pill or crush it into powder before administering it. It is crucial to emphasize that sustained-release tablets must be swallowed whole and must not be broken, crushed, chewed, or ground!

The special structure used in the production of sustained-release formulations ensures the slow and stable release of the medication. If the original structure is compromised through external force, it may cause the active ingredients to be released rapidly in the child’s body, potentially reaching a life-threatening dose, leading to severe side effects, including respiratory depression, and significantly increasing the risk of addiction.

In recent years, some non-professionals have suggested administering medication rectally to children who cannot swallow or have difficulty taking medicine. I strongly advise against this, as rectal administration may lead to excessively high drug concentrations, resulting in severe toxic side effects and even the risk of death.

Additionally, children often have a strong aversion to rectal administration and may be very uncooperative. If the medication is administered too shallowly, the child may quickly expel it, wasting the medication without achieving pain relief. Conversely, if administered too deeply, it can cause significant discomfort and lead to fear and resistance from the child. Therefore, for children who cannot take oral medications, alternatives such as patches or subcutaneous pain pumps should be considered instead of attempting to administer oral medications rectally.

Take it on time, not just when in pain

Sustained-release tablets should be taken on a regular schedule, typically every 12 hours (for example, once at 8:00 AM and once at 8:00 PM). The optimal pain relief effect is generally achieved 2 to 3 hours after ingestion, lasting about 12 hours. Thus, taking the medication every 12 hours maintains a stable concentration of the drug in the body, achieving consistent pain relief. Therefore, it is important to take the medication regularly, regardless of whether pain is present.

Do not stop taking the medication or adjust the dosage on your own!

If a child suddenly stops taking the medication after long-term use, withdrawal symptoms may occur, manifesting as restlessness, tearfulness, yawning, chills, muscle and bone pain, etc. If a child truly needs to stop the medication, it must be done gradually under a doctor's guidance; never stop the medication abruptly!

Generally, if the morphine dosage is between 30-60mg/day, it can be stopped directly. For those who have been on long-term high-dose therapy, the dosage should be gradually reduced while monitoring the child's pain and mental status. If pain control is inadequate, contact a specialist to adjust the dosage under medical supervision.

What side effects may sustained-release formulations cause?

Possible adverse reactions after taking sustained-release formulations include dizziness, headache, loss of appetite, drowsiness, constipation, nausea, vomiting, and skin itching. Most adverse reactions can be self-managed by children within 3 to 5 days, requiring only observation or symptomatic treatment by parents and doctors.

However, constipation is the only side effect that most children cannot tolerate. Parents can encourage their children to drink more water, eat more fruits and vegetables, and exercise appropriately. If necessary, laxatives can be used, as these methods can help alleviate the issue.

It is important to note that overdose of sustained-release formulations can lead to respiratory depression, which is a very dangerous side effect that parents must monitor closely.

If parents observe any of the aforementioned adverse reactions during their child's medication period, they should promptly contact a specialist for symptomatic treatment.

Can sustained-release tablets cause addiction?

If the specialist's medication instructions are strictly followed, and the medication is taken on time and at the correct dosage, the probability of addiction is extremely low. If parents still have concerns, they should consult a specialist before starting the medication.

Which children are not suitable for sustained-release formulations?

- Non-cancer pain

- Children with pain requiring short-term treatment or early-stage cancer pain should use with caution

- Difficulty eating

- Severe respiratory distress

- Severe intracranial hypertension with projectile vomiting

- Pre-existing severe urinary retention without a plan for catheterization

- Severe ascites, significant abdominal distension from various causes, or paralytic ileus

References:

1. Relevant drug instructions

2. Oxford Textbook: Pediatric Palliative Care

Book Introduction: As human life expectancy increases, issues related to pain are becoming more prevalent. To help people better understand pain, multiple experts have summarized years of clinical experience, presenting a detailed introduction to the basic understanding, diagnosis, treatment, and management of pain in simple and accessible language, suitable for patients with pain or their families.

Column Author: Professor Guo Yanru

Deputy Chief Physician, Palliative Care Department, Cangzhou People's Hospital, Hebei Province

Illustration: Wu Yuanyuan

Editor: Zuo Jia, Xia Yu

Typesetting: Xia Yu

Proofreading: Gou Er