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Methadone Hydrochloride

Medical and Pharmacy Editor:

Brand Name: Methadose, Dolophine

Generic Name: methadone hydrochloride

Drug Class: Opioid Analgesics

What Is Methadone Hydrochloride and How Does It Work?

Methadone 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.

Dosages of Methadone Hydrochloride

Adult Dosage Forms & Strengths

Injectable solution: Schedule II

  • 10mg/mL

Tablet: Schedule II

  • 5mg
  • 10mg
  • 40mg (pediatric)

Dispersible tablet: Schedule II

  • 40mg

Oral solution: Schedule II

  • 5mg/5mL
  • 10mg/5mL

Oral concentrate solution: Schedule II

  • 10mg/mL

Dosage Considerations -- Should Be Given As Follows:

For Adults with Chronic Severe Pain

Indicated 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

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

Medically Reviewed by a Doctor on 4/14/2017



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