methadone

Pronunciation

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

What is methadone?

Methadone is an opioid medication. An opioid is sometimes called a narcotic. Methadone 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 is available only from a certified pharmacy.

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

What is the most important information I should know about methadone?

You should not use methadone if you have severe asthma or breathing problems, or a bowel obstruction called paralytic ileus.

Methadone can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use this medicine in larger amounts, or for longer than prescribed. Methadone may be habit-forming, even at regular doses. Never share this medicine 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.

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MISUSE OF NARCOTIC MEDICATION CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription.

Methadone may cause a life-threatening heart rhythm disorder. Call your doctor at once if you have a headache with chest pain and severe dizziness, and fast or pounding heartbeats.

Methadone is available only from a certified pharmacy.

What should I discuss with my healthcare provider before using methadone?

You should not use methadone if you are allergic to it, or if you have:

  • severe asthma or breathing problems; or

  • a bowel obstruction called paralytic ileus.

Methadone may cause a life-threatening heart rhythm disorder. Your heart function may need to be checked during treatment.

To make sure methadone is safe for you, tell your doctor if you have:

  • heart disease, or heart rhythm disorder;

  • personal or family history of long QT syndrome;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • any type of breathing problem or lung disease;

  • a history of head injury, brain tumor, or seizures;

  • a history of drug abuse, alcohol addiction, or mental illness;

  • urination problems;

  • liver or kidney disease;

  • problems with your gallbladder, pancreas, or thyroid.

Methadone is more likely to cause breathing problems in older adults and people who are severely ill, malnourished, or otherwise debilitated.

FDA pregnancy category C. It is not known whether methadone will harm an unborn baby. Methadone may cause breathing problems, behavior changes, or addiction and withdrawal symptoms in your newborn if you use the medication during pregnancy. Tell your doctor if you are pregnant.

Methadone can pass into breast milk and may cause breathing problems or addiction and withdrawal symptoms in a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use methadone?

Follow all directions on your prescription label. Methadone can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never use methadone in larger amounts, or for longer than prescribed. Tell your doctor if the medicine seems to stop working as well in relieving your pain.

Methadone may be habit-forming, even at regular doses. Never share this medicine with another person, especially someone with a history of drug abuse or addiction. MISUSE OF NARCOTIC MEDICATION CAN CAUSE ADDICTION, OVERDOSE, OR DEATH, especially in a child or other person using the medicine without a prescription. Selling or giving away methadone is against the law.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Dissolve the dispersible tablet in at least 4 ounces of water, orange juice, or other citrus-flavored non-alcoholic beverage. Allow the tablet to disperse in the liquid. The tablet will not dissolve completely. Drink this mixture right away. To get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

Never use methadone tablets or liquid to make a mixture for injecting the drug into your vein. This practice has resulted in death with the misuse of methadone and similar prescription drugs.

When methadone is used as part of a treatment program for drug addiction or detoxification, 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.

You should not stop using methadone suddenly. Follow your doctor's instructions about tapering your dose.

Store at room temperature away from moisture and heat. Keep the medication in a place where others cannot get to it.

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.

After you have stopped using this medication, flush any unused pills or liquid medicine down the toilet.

What happens if I miss a dose?

If you take methadone for pain: Take the missed dose as soon as you remember, then take your next dose 8 to 12 hours later. Skip the missed dose if it is almost time for your next scheduled dose.

If you take methadone for drug addiction: Take your missed dose the next day at the regular time. 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.

Do not use extra medicine to make up a missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A methadone overdose can be fatal, especially in a child or other person using the medicine without a prescription. Overdose symptoms may include slow breathing and heart rate, severe drowsiness, muscle weakness, cold and clammy skin, pinpoint pupils, and fainting.

What should I avoid while using methadone?

Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with methadone. 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 this medicine will affect you. Dizziness or severe drowsiness can cause falls or other accidents.

Grapefruit and grapefruit juice may interact with methadone and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Methadone side effects

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

Even if you have used other narcotic medications, you may still have serious side effects from methadone.

Call your doctor at once if you have:

  • weak or shallow breathing;

  • severe constipation;

  • a light-headed feeling, like you might pass out; or

  • symptoms of a life-threatening heart rhythm disorder--a headache with chest pain and severe dizziness, and fast or pounding heartbeats.

Common side effects may include:

  • dizziness, drowsiness;

  • nausea, vomiting; or

  • increased sweating.

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: Side effects (in more detail)

Methadone dosing 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.

What other drugs will affect methadone?

Taking this medicine with other drugs that make you sleepy or slow your breathing can cause dangerous or life-threatening side effects. Ask your doctor before taking methadone with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with methadone. Tell your doctor about all your medications and any you start or stop using during treatment with methadone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about methadone.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 4.03. Revision Date: 2014-05-01, 10:52:57 AM.

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