Methadone

Generic Name: methadone (METH a done)
Brand names: Diskets, Dolophine, Methadose, Methadose Sugar-Free

What is methadone?

Methadone is a opioid pain reliever, similar to morphine. An opioid is sometimes called a narcotic. It also reduces withdrawal symptoms in people addicted to heroin or other narcotic drugs without causing the "high" associated with the drug addiction.

Methadone is used as a pain reliever and as part of drug addiction detoxification and maintenance programs.

Methadone may also be used for purposes not listed in this medication guide.

Important information about methadone

Taking methadone improperly will increase your risk of serious side effects or death. Even if you have used other narcotic medications, you may still have serious side effects from methadone. Follow all dosing instructions carefully.

Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak. Never use more methadone than your doctor has prescribed. Call your doctor if you think the medicine is not working.

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Do not stop using methadone suddenly, or you could have unpleasant withdrawal symptoms. Call your doctor if you miss doses or forget to take this medication for longer than 3 days in a row. Do not drink alcohol. Methadone can increase the effects of alcohol, which could be dangerous. Check your food and medicine labels to be sure these products do not contain alcohol.

Methadone may impair your thinking or reactions. Avoid driving or operating machinery until you know how methadone will affect you.

Before using methadone

Taking methadone improperly will increase your risk of serious side effects or death. Even if you have used other narcotic medications, you may still have serious side effects from methadone. Follow all dosing instructions carefully. Methadone may be habit forming and should be used only by the person it was prescribed for. Never share methadone with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Do not use methadone if you have ever had an allergic reaction to a narcotic medicine (examples include codeine, morphine, Oxycontin, Darvocet, Percocet, Vicodin, Lortab, and many others). You should also not take methadone if you are having an asthma attack or if you have a bowel obstruction called paralytic ileus.

To make sure you can safely use methadone, tell your doctor if you have any of these other conditions:

• a personal or family history of "Long QT syndrome";

• asthma, COPD, sleep apnea, or other breathing disorders;

• liver or kidney disease;

• underactive thyroid;

• curvature of the spine;

• a history of head injury or brain tumor;

• epilepsy or other seizure disorder;

• low blood pressure;

• gallbladder disease;

• Addison's disease or other adrenal gland disorders;

• enlarged prostate, urination problems;

• mental illness; or

• a history of drug or alcohol addiction.

FDA pregnancy category C. It is not known whether methadone will harm an unborn baby. Methadone may cause addiction or withdrawal symptoms in a newborn if the mother takes the medication during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine. Methadone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

See also: Methadone pregnancy and breastfeeding warnings (in more detail)

Older adults and people with debilitating conditions may be more sensitive to the effects of this medication.

How should I use methadone?

Use methadone exactly as prescribed. Never use this medicine in larger amounts, or for longer than recommended by your doctor. Follow the directions on your prescription label. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Like other narcotic medicines, methadone can slow your breathing, even long after the pain-relieving effects of the medication wear off. Death may occur if breathing becomes too weak. Never use more methadone than your doctor has prescribed. Call your doctor if you think the medicine is not working.

When methadone is used as part of a treatment program for drug addiction or detoxification, you will receive the medication through a clinic or special pharmacy.

Your doctor may recommend that methadone be given to you by a family member or other caregiver. This is to make sure you are using the medicine as it was prescribed as part of your treatment.

Additional forms of counseling and/or monitoring may be recommended during treatment with methadone.

Methadone is available in tablets, dispersible tablets, oral solution (liquid) and as an injection. The pill and oral liquid forms of methadone must never be used to make a methadone injection.

Measure the liquid form of methadone with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

The methadone dispersible tablet (Diskets) is made to be dissolved in water. Do not chew, crush, or swallow the tablet whole. Place the tablet into a 4-ounce glass of water, orange juice, or other citrus-flavored non-alcoholic beverage and allow the tablet to disperse in the liquid. The tablet will not dissolve completely. Drink this mixture right away. To make sure you get the entire dose, add a little more liquid to the same glass, swirl gently and drink right away.

Store methadone at room temperature away from moisture and heat.

After you have stopped using methadone, flush any unused pills down the toilet. Disposal of medicines by flushing is recommended to reduce the danger of accidental overdose causing death. This advice applies to a very small number of medicines only. The FDA, working with the manufacturer, has determined this method to be the most appropriate route of disposal and presents the least risk to human safety.

Keep track of how much of this medicine has been used. Methadone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

If you miss your doses for longer than 3 days in a row, call your doctor for instructions. You may need to restart methadone at a lower dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of methadone can be fatal, especially if you take it with alcohol or other narcotic medications.

Overdose symptoms may include extreme drowsiness, pinpoint pupils, confusion, cold and clammy skin, weak pulse, shallow breathing, fainting, or breathing that stops.

What should I avoid while using methadone?

Do not drink alcohol. Methadone can increase the effects of alcohol, which could be dangerous. Check your food and medicine labels to be sure these products do not contain alcohol. This medication may impair your thinking or reactions. Avoid driving or operating machinery until you know how methadone will affect you.

Methadone side effects

Get emergency medical help if you have any of these signs of an allergic reaction to methadone: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• shallow breathing;

• hallucinations or confusion;

• chest pain, dizziness, fainting, fast or pounding heartbeat; or

• trouble breathing, feeling light-headed, or fainting.

Less serious methadone side effects may include:

• feeling anxious, nervous, or restless;

• sleep problems (insomnia);

• feeling weak or drowsy;

• dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite; or

• decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

See also: Methadone side effects (in more detail)

Methadone Dosing Information

Usual Adult Dose for Pain:

Oral: 2.5 to 10 mg every 3 to 12 hours.
IV, IM, subcutaneously: 2.5 to 10 mg every 3 to 6 hours.

Usual Adult Dose of Methadone 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 opiate 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 Methadone 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.

What other drugs will affect methadone?

Do not use methadone with any other opioid pain medications, sedatives, tranquilizers, sleeping pills, muscle relaxers, or other medicines that can make you sleepy or slow your breathing. Dangerous side effects may result.

Tell your doctor about all other medicines you use, especially:

• a diuretic (water pill);

• antibiotics such as azithromycin (Zithromax), ciprofloxacin (Cipro), clarithromycin (Biaxin), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), itraconazole (Sporanox), ketoconazole (Nizoral), metronidazole (Flagyl) or voriconazole (Vfend);

• heart or blood pressure medication such as diltiazem (Cardizem, Cartia, Dilacor, Tiazac) or verapamil (Calan, Covera, Isoptin, Verelan);

• HIV medicines such as abacavir (Ziagen), didanosine (Videx), efavirenz (Atripla, Sustiva), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Kaletra, Norvir), stavudine (Zerit), or zidovudine (Retrovir);

• a MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate);

• other narcotic medications such as pentazocine (Talwin), nalbuphine (Nubain), buprenorphine (Subutex), or butorphanol (Stadol);

• rifampin (Rifadin, Rimactane, Rifater); or

• seizure medication such as phenobarbital (Solfoton) or phenytoin (Dilantin).

This list is not complete and there are many other drugs that can interact with methadone. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

• Your pharmacist can provide more information about methadone.