Methadone Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Pain

Oral: Starting dose 2.5 mg to 10 mg every 8 to 12 hours. Dose may be slowly titrated to effect. More frequent administration may be required to maintain adequate analgesia however extreme caution is necessary to avoid overdosage, taking into account methadone’s long elimination half-life.
IV, IM, subcutaneously: Starting dose 2.5 mg to 10 mg every 8 to 12 hours. Dose may be slowly titrated to effect. More frequent administration may be required to maintain adequate analgesia however extreme caution is necessary to avoid overdosage, taking into account methadone’s long elimination half-life.

Usual Adult Dose for Opiate Withdrawal

Initial Dose: 15 to 40 mg once a day. The oral route is preferred unless the patient is unable to ingest oral methadone, then parenteral form can be used. 5 to 10 mg additional doses may be given if symptoms of abstinence are distressing.
After one or two days, a 20% daily reduction in dose can usually be tolerated. Detoxification can usually be completed within 10 days.
Maintenance of opioid dependence: 20 to 120 mg/day.

Oral - Diskets:
Induction/Initial Dosing:
The initial methadone dose should be administered, under supervision, when there are no signs of sedation or intoxication, and the patient shows symptoms of withdrawal.
Initial dose: a single dose of 20 to 30 mg of methadone will often be sufficient to suppress withdrawal symptoms. The initial dose should not exceed 30 mg.
If same day dosing adjustments are to be made, the patient should be asked to wait two to four hours for further evaluation, when peak levels have been reached. An additional 5 to 10 mg of methadone may be provided if withdrawal symptoms have not been suppressed or if symptoms reappear. The total daily dose of methadone on the first day of treatment should not ordinarily exceed 40 mg. Dose adjustments should be made over the first week of treatment based on control of withdrawal symptoms at the time of expected peak activity (e.g., 2 to 4 hours after dosing). Dose adjustment should be cautious; deaths have occurred in early treatment due to the cumulative effects of the first several days dosing. Because diskets can be administered only in 10 mg increments, diskets may not be the appropriate product for initial dosing in many patients. Patients should be reminded that the dose will "hold" for a longer period of time as tissue stores of methadone accumulate.
Initial doses should be lower for patients whose tolerance is expected to be low at treatment entry. Loss of tolerance should be considered in any patient who has not taken opioids for more than five days. Initial doses should not be determined by previous treatment episodes or dollars spent per day on illicit drug use.
For Short-term Detoxification:
For patients preferring a brief course of stabilization followed by a period of medically supervised withdrawal, it is generally recommended that the patient be titrated to a total daily dose of about 40 mg in divided doses to achieve an adequate stabilizing level. Stabilization can be continued for 2 to 3 days, after which the dose of methadone should be gradually decreased. The rate at which methadone is decreased should be determined separately for each patient. The dose of methadone can be decreased on a daily basis or at two day intervals, but the amount of intake should remain sufficient to keep withdrawal symptoms at a tolerable level. In hospitalized patients, a daily reduction of 20% of the total daily dose may be tolerated. In ambulatory patients, a somewhat slower schedule may be needed. Because diskets can be administered only in 10 mg increments, diskets may not be the appropriate product for gradual dose reduction in many patients.
For Maintenance Treatment:
Patients in maintenance treatment should be titrated to a dose at which opioid symptoms are prevented for 24 hours, drug hunger or craving is reduced, the euphoric effects of self-administered opioids are blocked or attenuated, and the patient is tolerant to the sedative effects of methadone. Most commonly, clinical stability is achieved at doses between 80 to 120 mg/day.
For Medically Supervised Withdrawal After a Period of Maintenance Treatment:
There is considerable variability in the appropriate rate of methadone taper in patients choosing medically supervised withdrawal from methadone treatment. It is generally suggested that dose reductions should be less than 10% of the established tolerance or maintenance dose, and that 10 to 14 day intervals should elapse between dose reductions. Because diskets can be administered only in 10 mg increments, it may not be the appropriate product for gradual dose reduction in many patients. Patients should be apprised of the high risk of relapse to illicit drug use associated with discontinuation of methadone maintenance treatment.

Usual Pediatric Dose for Pain

Note: Doses should be titrated to appropriate effects:
Neonatal abstinence syndrome:
Oral or IV:
Initial: 0.05 to 0.2 mg/kg/dose given every 12 to 24 hours or 0.5 mg/kg/day divided every 8 hours. Individualize dose and tapering schedule to control symptoms of withdrawal. Usually taper dose by 10 to 20% per week over 1 to 1 and 1/2 months. Note: Due to long elimination half-life, tapering is difficult; consider alternate agent.

Note: Doses should be titrated to appropriate effects:
Children:
Analgesia: Note: Dosing interval may range from 4 to 12 hours during initial therapy. Decrease in dose or frequency may be required approximately 2 to 5 days after initiation of therapy or dosage increase due to accumulation with repeated doses.
IV:
Initial: 0.1 mg/kg/dose every 4 hours for 2 to 3 doses, then every 6 to 12 hours as needed
Maximum dose: 10 mg/dose
Oral, IM, SubQ:
Initial: 0.1 mg/kg/dose every 4 hours for 2 to 3 doses, then every 6 to 12 hours as needed or 0.7 mg/kg/24 hours divided every 4 to 6 hours as needed
Maximum dose: 10 mg/dose

Iatrogenic narcotic dependency:
Oral:
Controlled studies have not been conducted. Several clinically used dosing regimens have been reported. Methadone dose must be individualized and will depend upon the previous narcotic dose and severity of opioid withdrawal. Patients who have received higher doses of narcotics will require higher methadone doses.
General guidelines:
Initial: 0.05 to 0.1 mg/kg/dose every 6 hours
Increase by 0.05 mg/kg/dose until withdrawal symptoms are controlled. After 24 to 48 hours, the dosing interval can be lengthened to every 12 to 24 hours. To taper dose, wean by 0.05 mg/kg/day. If withdrawal symptoms recur, taper at a slower rate.

Renal Dose Adjustments

CrCl less than 10 mL/min: The dose should be given at 50% to 75% of the normal dose.

Liver Dose Adjustments

Data not available

Dose Adjustments

The pain dose may be titrated 2.5 to 5 mg increments. Most patients require less than 80 mg/day.

Dosage adjustment using higher doses or administering the daily dose in divided doses may be necessary in pregnant women treated with methadone.

Precautions

Methadone should be used with caution in patients with hepatic or renal impairment, hypothyroidism, Addison's disease, prostatic hypertrophy or urethral stricture.

Dialysis

Methadone is not dialyzed. Less than 1% of a methadone dose is removed by hemodialysis or peritoneal dialysis.

Other Comments

Detoxification can not exceed 21 days. It should not be repeated within 4 weeks of prior course.

Oral - Diskets:
Diskets are intended for dispersion in a liquid immediately prior to oral administration of the prescribed dose. The tablets should not be chewed or swallowed before dispersing in liquid. Diskets are cross-scored, allowing for flexible dosage adjustment. Each tablet may be broken or cut in half to yield two 20 mg doses, or in quarters to yield four 10 mg doses. Prior to administration, the desired dose of diskets should be dispersed in approximately 120 mL (4 ounces) of water, orange juice, Tang, citrus flavors of Kool- Aid or other acidic fruit beverage prior to taking. Methadone hydrochloride is very soluble in water, but there are some insoluble excipients that will not entirely dissolve.
If residue remains in the cup after initial administration, a small amount of liquid should be added and the resulting mixture administered to the patient.

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