Adults
PO Start with 1:2 dose ratio (eg, parenteral methadone 5 mg to oral methadone 10 mg).
Detoxification and Maintenance Treatment of Opiate DependenceAdults
IV/IM/Subcutaneous/PO For detoxification and maintenance of opiate dependence, methadone should be administered in accordance with the treatment standards cited in the Code of Federal Regulation, Title 42, Section 8.12, including limitations on unsupervised administrations.
InductionAdults Buy Methadone
PO Start with 20 to 30 mg to suppress withdrawal symptoms. For same-day dosing adjustments, wait 2 to 4 h for further evaluation when peak levels are reached. An additional 5 to 10 mg may be administered if withdrawal symptoms have not been suppressed or if symptoms reappear (max, 40 mg the first day). Dose adjustments should be made over the first week of treatment based on control of withdrawal symptoms at the time of expected peak activity (eg, 2 to 4 h after dosing). Initial doses should be lower for patients whose tolerance is expected to be low at the beginning of treatment.
Initiation of Therapy in Opioid Nontolerant PatientsAdults
IV/IM/Subcutaneous/PO When used as the first analgesic in patients who are not already being treated with, and tolerant to, opioids, start with 2.5 to 10 mg every 8 to 12 h. Slowly titrate to effect. More frequent administration may be required during initiation in order to maintain adequate analgesia.
Maintenance Buy MethadoneAdults
PO Most commonly, clinical stability is achieved at dosages between 80 and 120 mg/day. Titrate to a dose at which opioid symptoms are prevented for 24 h, 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.
Medically Supervised Withdrawal After a Period of Maintenance TreatmentAdults
PO It is generally suggested that the 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.
Short-Term DetoxificationAdults
PO Titrate patients to a total daily dose of about 40 mg in divided doses to achieve an adequate stabilization level. Continue stabilization for 2 to 3 days, after which the dose should be gradually decreased. The rate of decrease should be determined for each patient. The dose can be decreased on a daily basis or at 2-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.
Switching Patients to Methadone From Other Chronic Opioids Buy MethadoneAdults
IV/PO Use the following guidelines for oral morphine to methadone conversion:
Total daily baseline oral morphine dose Morphine less than 100 mg The estimated daily oral methadone requirement as a percent of total daily oral morphine dose is 20% to 30% (IV, 10% to 15%).
