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Description

What is Methadone Hydrochloride?

Methadone Hydrochloride is used to treat addiction to opioids (such as heroin) as part of an approved treatment program. Methadone belongs to a class of drugs known as opioid (narcotic) analgesics. It helps prevent withdrawal symptoms caused by stopping other opioids.

Methadone may also be used to treat severe pain. Do not use methadone to relieve pain that is mild or that will go away in a few days. Methadone is not for occasional (“as needed”) use.

Methadone is available under the following different brand and other names: Methadose, and Dolophine.

Dosage of Methadone Hydrochloride

Opioid-naive patients: 2.5 mg taken orally once every 8-12 hours; titrate slowly with dose increases no more frequent than every 3-5 days

Opioid-tolerant patients

Discontinue all other around-the-clock opioids
Substantial inter-patient variability, see prescribing information for guidance
Opioid-tolerant definition

Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression
Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mg/day oral morphine, 25 mcg/hour transdermal fentanyl, 30 mg/day oral oxycodone, 8 mg/day oral hydromorphone, 25 mg/day oral oxymorphone, or an equianalgesic dose of another opioid
Limitations of use

Use of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve for patients whom alternative treatment options (e.g., non-opioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain
Not indicated for acute pain or as an as needed analgesic
Detoxification
20-30 mg taken orally once daily or minimum dosage necessary to suppress withdrawal; may be titrated to 40 mg/day in divided doses and continued for 2-3 days, then decreased 20% daily as tolerated

Dosing Modifications
Renal impairment (CrCl less than 10mL/min): 50-75% of normal dose

Hepatic impairment: Not recommended in severe liver disease

Dosing Considerations
Conversion from oral to parenteral: Parenteral-to-oral ratio, 1:2 (5 mg parenteral = 10 mg taken orally)

To convert to methadone from another opioid, use available conversion factors to obtain estimated dose

Do not abruptly discontinue methadone in a physically dependent patient

Pediatric

Pain (Off-label)
0.7 mg/kg/day orally/subcutaneously/intravenously(IV)/intramuscularly (IM) divided once every 6 hours as needed; not to exceed 10 mg/dose

Opiate Withdrawal (Off-label)
Neonates: 0.05-0.2 mg/kg taken orally once every 12-24 hours; reduce dose by 10-20% per week over 4-6 weeks; adjust tapering on signs and symptoms of withdrawal

Geriatric
Pain
2.5 mg orally or intramuscularly (IM) once every 8-12 hours; titrate slowly with dose increases no more frequent than every 3-5 days

Detoxification
20-30 mg taken orally once daily or minimum dosage necessary to suppress withdrawal; may be titrated to 40 mg/day in divided doses and continued for 2-3 days, then decreased 20% daily as tolerated

Side Effects of Methadone Hydrochloride

Side effects of methadone include:
Agitation
Anticholinergic effects (dry mouth, palpitation, fast heart rate)
Cardiac arrest
Chest pain
Coma
Constipation
Dizziness
Drowsiness
Feeling uneasy
Euphoria
Heart attack (myocardial infarction)
Itching and hives
Lightheadedness or fainting
Mental clouding or depression
Nausea
Nervousness
Respiratory arrest
Respiratory/circulatory depression
Restlessness
Seizures
Severe cardiac arrhythmias
Shock
Slow heart rate
Sweating, flushing, warmness of face/neck/throat
Urinary retention, urinating less than usual
Visual disturbances
Vomiting
Weakness

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