Methadone Overview

Methadone is part of a category of drugs called opioids. German doctors created it during World War II. When it came to the United States, doctors used it to treat people with extreme pain. Today, you might also get it as part of a treatment program for an addiction to heroin or narcotic painkillers.

Methadone changes the way your brain and nervous system respond to pain so that you feel relief. Its effects are slower than those of other strong painkillers like morphine. Your doctor may prescribe methadone if you’re in a lot of pain from an injury, surgery, or long-term illness.

It also blocks the high from drugs like codeine, heroin, hydrocodone, morphine, and oxycodone. It can give a similar feeling and keep you from having withdrawal symptoms and cravings. You may hear this called replacement therapy.

It’s usually just one part of your treatment plan. It isn’t a cure for addiction.

TITRATION and MAINTENANCE:

• Titrate to a dose that provides adequate analgesia and minimizes adverse reactions; dose adjustments should be no sooner than every 1 to 2 days (manufacturer); preferably no more than once a week (Institute for Safe Medical Practices (ISMP)); with repeated dosing the potency of methadone increases due to systemic accumulation
• Breakthrough Pain: If the level of pain increases after dose stabilization, attempt to identify the source before increasing dose; rescue medication with appropriate immediate-release analgesia may be helpful.

Comments:

• ISMP suggests when prescribing this drug for pain, consider all patients as opioid naive; consider limiting the starting dose to oral doses not exceeding 20 mg per day (10 mg for the elderly or infirmed) and limit dose adjustments to once a week to allow steady state levels to develop.
• Prescribe oral liquid doses in milligrams (mg) to avoid confusion.
• Dose conversion should be done carefully and with close monitoring due to large patient variability to opioid analgesic response.
• This drug is not indicated as an as-needed analgesic.
• Upon cessation of therapy, gradually taper dose in physically dependent patient.
• Because of the risks of addiction, abuse, and misuse, even at recommended doses, and because of the greater risk of overdose and death with long-acting opioids, this drug should be reserved for use in patients for whom alternative analgesic treatment options are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient pain management.

Use: For the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

Renal Dose Adjustments

Renal impairment: Start at the low end of the dosing range using longer dosing intervals and titrate slowly; closely monitor for signs of respiratory and CNS depression.

Liver Dose Adjustments

Hepatic impairment: Start at the low end of the dosing range and titrate slowly; closely monitor for signs of respiratory and CNS depression.