What is methadone? What is methadone used for?
Methadone is a strong,
synthetic (man-made) narcotic that acts on the central
nervous system (brain) in a manner similar to other narcotics. It is used in
the management of narcotic addiction and for pain control. Methadone was
first approved by the Food and Drug Administration on August 13, 1947.
What brand names are available for methadone?
Dolophine; Methadone HCl Intensol; Methadose; Methadose Sugar-Free
Is methadone available as a generic drug?
Yes
Do I need a prescription for methadone?
Yes
What are the uses for methadone?
Methadone is used for the treatment of moderate to
severe pain when non-narcotic pain medications have failed. The extended release
methadone tablets should be reserved for severe and continuous pain that
requires long-term pain treatment after a failed trial of non-narcotic
medications and should be avoided in individuals requiring as-needed pain
control.
What are the side effects of methadone?
Methadone is very addicting and causes
significant sedation and respiratory depression. Methadone side effects include:
- constipation,
- tomach upset,
- nausea,
- shallow breathing,
- hallucinations,
- confusion,
- chest pain,
- dizziness,
- drowsiness,
- fainting,
- fast or pounding
heartbeat, - trouble breathing,
- feeling light-headed,
- fainting, and
- flushing
These tend to occur during the
first few days as the body adjusts to the medication. Methadone also may cause:
Some of these
side effects may go away with continued use.
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What is the dosage for methadone?
- The initial dose of oral methadone in patients who
require continuous pain control throughout the day can range from 2.5 to 10 mg
given every 8 to 12 hours. - Those who are seriously ill may need to be started at
an oral dose of 10 to 40 mg given every 6 to 12 hours. - The initial total daily
dose for detoxification usually is higher, and this can range from 20 to 120 mg
daily. - The usual dose for methadone solution for injection when treating
moderate to severe pain in patients who require continuous pain control is 2.5
to 10 mg given as intravenous (I.V.), subcutaneous (SubQ) or intramuscular
(I.M.) injection every 8-12 hours. - The conversion ratio from oral methadone to
methadone given as an injection (I.V., SubQ) or I.M.) is 2:1. The total daily
amount of methadone that a person is prescribed is not fixed, and it will depend
on many factors including the severity of the pain, prior use of methadone,
medications that are being taken concomitantly, the response to treatment and
other factors that may be specific to a person. - Therefore, each person has to be
monitored carefully while receiving methadone. When stopping therapy, the dose
of methadone should be gradually reduced in order to avoid withdrawal symptoms.
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Which drugs or supplements interact with methadone?
- Methadone when taken with drugs that slow
brain function, such as alcohol and barbiturates (phenobarbital), can increase
the effects of these drugs. - Because methadone causes
constipation,
taking antidiarrheal medications such as diphenoxylate (Lomotil) and
loperamide
(Imodium) along with methadone can result in severe constipation. - Drugs that
block narcotic (opioid) receptors including
pentazocine
(Talwin),
nalbuphine (Nubain), naloxone (Narcan),butorphanol (Stadol) and
buprenorphine (Subutex) can lead to withdrawal symptoms.
- Rifampin (Rifadin), barbiturates,
carbamazepine (Tegretol),
phenytoin
(Dilantin), primidone and St. John’s wort preparations can increase the liver‘s
ability to metabolize (eliminate) methadone and reduce its blood concentration
which could result in withdrawal side effects, while drugs such as erythromycin
(E-Mycin, Eryc, Ery-Tab), clarithromycin (Biaxin, Biaxin XL), ketoconazole
(Nizoral), and itraconazole (Sporanox) can decrease the liver’s ability to
metabolize methadone thereby increasing the side effects of this drug. - Anti-retroviral agents including abacavir (Ziagen), amprenavir (Agenerase),
efavirenz (Sustiva), nelfinavir (Viracept), Nevirapine (Viramune, Viramune XR),
Ritonavir (Norvir), and lopinavir/ ritonavir (Kaletra) have been shown to
decreased the blood levels of methadone making it necessary to adjust the dose
of methadone to prevent narcotic withdrawal effects. - Some drugs that slow the heart rate for example, dofetilide (Tikosyn),
procainamide (Pronestyl, Procan-SR), quinidine, and sotalol (Betapace), as well
as laxatives and diuretics that cause low magnesium or low potassium in the
body, for example, furosemide (Lasix), can cause rare serious and fatal
irregular heartbeats.
Is methadone safe to take if I’m pregnant or breastfeeding?
Safety during
pregnancy has not
been established. Methadone has been shown to cross the placenta, and it is
found in cord blood, amniotic fluid and in the newborn urine. Children born to
mothers who were taking methadone for a prolonged period may exhibit respiratory
depression or withdrawal symptoms. Methadone enters breast milk, and this can
cause sedation and respiratory depression in the breast feeding infant. The
benefit to the mother of taking methadone while breast feeding should be weighed
against the risks to the infant.
What else should I know about methadone?
What preparations of methadone are available?
- Oral concentrate: 10 mg/mL;
- Oral solution: 5
and 10 mg per teaspoon; - Oral tablet: 5 mg and 10 mg;
- Soluble tablet, 40mg;
- Solution for Injection 5 and 10 mg per teaspoon: 10 mg/mL.
How should I keep methadone stored?
Oral methadone and injection should be stored at
room temperature between 15 C and 30 C (59 F and 86 F). Methadone
injection also should be protected from light.