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Medically reviewed by Drugs. Last updated on Oct 14, Individualize dose; dosing recommendations should only be considered as suggested approaches to what is actually a series of clinical decisions over time in the management of the pain of each individual patient; this drug has a narrow therapeutic index, especially when combined with other drugs; monitor patients closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy. Comments: -May be administered IV, IM or subcutaneously, although the absorption of IM or subcutaneous injections has not been well studied and appears to be unpredictable; local tissue reactions may occur. CONVERSION: Switching a patient from another chronically administered opioid to methadone requires caution due to the uncertainty of dose conversion ratios and incomplete cross-tolerance; deaths have occurred in opioid tolerant patients during conversion. When prescribing this drug for pain, might be best to consider all patients opioid naive; limit dose adjustments to once a week to allow steady state levels to develop. Uses: For the treatment of moderate to severe pain not responsive to non-narcotic analgesics. For detoxification and maintenance of opioid dependence, the drug should be administered in accordance with the treatment standards cited in 42 CFR Code of Federal Regulations Section 8. Oral : Day 1: Administer initial dose under supervision when symptoms of withdrawal are present. Short-term Detoxification: -For a brief course of stabilization followed by a period of medically supervised withdrawal, titrate to a total daily dose around 40 mg per day in divided doses; after 2 to 3 days, gradually decrease the dose at 2-day intervals maintaining sufficient dose to keep withdrawal symptoms at a tolerable level. Titration and Maintenance of Opioid Dependence Detoxification : -Titrate to a dose that prevents opioid withdrawal, reduces drug hunger or cravings, and blocks or attenuates the euphoric effects of self-administered opioids while ensuring the patients is tolerant to the sedative effects. Parenteral: -Injectable methadone products may be used in the temporary treatment of opioid dependence in patients unable to take oral medication. Comments: -Use lower dose for patients whose tolerance is expected to be low at treatment entry. Uses: For detoxification and maintenance treatment of opioid addiction in conjunction with appropriate social and medical services. As the First Opioid Analgesic : Initial dose: 2. Conversion from Parenteral Methadone to Oral Methadone: -Use a conversion ratio of for oral to parenteral e. 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. 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 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. Hepatic impairment: Start at the low end of the dosing range and titrate slowly; closely monitor for signs of respiratory and CNS depression. Elderly patients: Start at the low end of the dosing range and closely monitor for signs of respiratory and CNS depression. Concomitant use with CNS depressants: -Assess the appropriateness of concomitant use -If the decision is made to begin this drug: Initial dose: 2. Cessation of chronic pain therapy : -In physically-dependent patient: Gradually reduce dose every 2 to 4 days Cessation of opiate-dependence therapy: -There is considerable variability in the rate at which patients taper off; abrupt discontinuation is not advised. This drug should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. It includes a medication guide and elements to assure safe use. For additional information: www. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers. The peak respiratory depressant effect occurs later, and persists longer than the peak analgesic effect, especially during the initial dosing period. Monitor for respiratory depression, especially during initiation or following a dose increase. Most cases involve patients being treated for pain with large, multiple daily doses, although cases have been reported in patients receiving doses commonly used for maintenance treatment of opioid addiction. Closely monitor patients with risk factors for development of prolonged QT interval, a history of cardiac conduction abnormalities, and those taking medications affecting cardiac conduction for changes in cardiac rhythm during initiation and titration. In addition, discontinuation of concomitantly used CYP 3A4 2B6, 2C19, or 2C9 inducers may also result in an increase in methadone plasma concentration. Follow patients closely for respiratory depression and sedation, and consider dose reduction with changes to drugs affecting CYP isoenzymes listed above. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available. Reserve concomitant use for those patients for whom alternatives are inadequate; limit dose and duration to the minimum required for patients being treated for pain; monitor for signs and symptoms of respiratory depression and sedation, if patient is visibly sedated, evaluate the cause and consider delaying or omitting the daily dose. Administration advice : -This drug should be taken at approximately the same time every day; taking in the evening one day and the morning the following day can lead to an overdose. Oral: -DISKETS are intended for dispersion in approximately mL of liquid; take immediately after dispersing into water, orange juice, or other acidic fruit beverage. Oral liquid doses : -All orders should include mg strength as there are multiple concentrations available. Parenteral: -May be administered IV, IM or subcutaneously; IM or subcutaneous injections have not been well studied and absorption appears to be unpredictable; local tissue reactions may occur. Storage requirements: -Protect from light General : -Acidification of the urine may enhance urinary excretion of this drug. Monitoring : -Monitor closely for respiratory depression, especially within the first 24 to 72 hours of initiating therapy and following dose increases. Patient advice : -Patients should be instructed to read the US FDA-approved Medication Guide each time this drug is dispensed; they should understand the safe use, serious risks, and proper storage and disposal of this drug. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Other brands: Dolophine , Methadose , Methadone Diskets. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Available for Android and iOS devices. Subscribe to Drugs. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. We comply with the HONcode standard for trustworthy health information - verify here. Skip to Content. Methadone Dosage Medically reviewed by Drugs. Drug Status Rx. Availability Prescription only. Akorn, Inc. Mallinckrodt Inc. Mylan Pharmaceuticals Inc. Drug Class. Narcotic analgesics. Related Drugs. Methadone Images. Subscribe to our newsletters. FDA alerts for all medications. Daily news summary. Weekly news roundup. Monthly newsletter. I accept the Terms and Privacy Policy. Email Address. Explore Apps. About About Drugs. All rights reserved.

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