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treatment & management

Drug Profiles:
Methadone

Why is this medication prescribed?
When most people think of Methadone, they think of it only in the context of its being used in treatment programs for people addicted to narcotics. However, Methadone is also used to relieve severe pain. Some Migraineurs, especially those with intractable Migraine, have found it quite helpful.

Before Using This Medicine

  • tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially other pain relievers; antidepressants; medications for cough, cold, or allergies; sedatives; sleeping pills; tranquilizers; and vitamins.
  • tell your doctor if you have or have ever had liver or kidney disease, a history of alcoholism, lung or thyroid disease, heart disease, prostatic hypertrophy, or urinary problems.
  • tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking methadone, call your doctor.
  • if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking methadone.
  • you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
  • remember that alcohol can add to the drowsiness caused by this drug.

 

Allergies-
Tell your doctor and pharmacist if you are allergic to codeine, methadone, or any other drugs.

Pregnancy-

  • Safe use in pregnancy has not been established in relation to possible adverse effects on fetal development. Therefore, methadone should not be used in pregnant women unless, in the judgment of the physician, the potential benefits outweigh the possible hazards.
  • Methadone is not recommended for obstetric analgesia because its long duration of action increases the probability of respiratory depression in the newborn.
     

Breast-feeding-
Most narcotic analgesics have not been reported to cause problems in nursing babies. However, when the mother is taking large amounts of methadone, the nursing baby may become dependent on the medicine.

Children-
Methadone is not recommended for use as an analgesic in children, since documented clinical experience has been insufficient to establish a suitable dosage regimen for the pediatric age group.

Older adults-
Elderly people are especially sensitive to the effects of narcotic analgesics. This may increase the chance of side effects, especially breathing problems, during treatment.

Other medicines-
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a narcotic analgesic, it is especially important that your health care professional know if you are taking any of the following:

  • Central nervous system (CNS) depressants or
  • Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], pargyline [e.g., Eutonyl], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], tranylcypromine [e.g., Parnate] (taken currently or within the past 2 weeks) or
  • Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])
  • Naltrexone (e.g., Trexan)—Narcotics will not be effective in people taking naltrexone
  • Rifampin (e.g., Rifadin)—Rifampin decreases the effects of methadone and may cause withdrawal symptoms in people who are dependent on methadone

Other medical problems-
The presence of other medical problems may affect the use of narcotic analgesics. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse, or history of, or
  • Drug dependence, especially narcotic abuse, or history of, or
  • Emotional problems—The chance of side effects may be increased; also, withdrawal symptoms may occur if a narcotic you are dependent on is replaced by buprenorphine, butorphanol, nalbuphine, or pentazocine
  • Brain disease or head injury or
  • Emphysema, asthma, or other chronic lung disease or
  • Enlarged prostate or problems with urination or
  • Gallbladder disease or gallstones—Some of the side effects of narcotic analgesics can be dangerous if these conditions are present
  • Colitis or
  • Heart disease or
  • Kidney disease or
  • Liver disease or
  • Underactive thyroid—The chance of side effects may be increased
  • Convulsions (seizures), history of—Some of the narcotic analgesics can cause convulsions

Proper Use of This Medicine

  • Methadone comes as a tablet, dispersible tablet, liquid, and liquid concentrate to take by mouth. It usually is taken every 3-4 hours as necessary for severe pain or every 6-8 hours for chronic pain. If you take methadone as part of a treatment program, your doctor will prescribe the dosing schedule that is best for you. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take methadone exactly as directed.
  • Methadone can be habit-forming. Do not take a larger dose, take it more often, or for a longer period than your doctor tells you to.
  • Dispersible tablets should be put in 3-4 ounces of liquid (e.g., water or citrus fruit juice) before use. The tablet should be completely dissolved in 1 minute.
  • When the methadone oral concentrate solution is used, the dose should be mixed in 3-4 ounces of liquid (e.g., water or citrus fruit juice) first.
  • If you take methadone as part of a treatment program, you must go to an approved clinic to obtain (and sometimes take) the drug. Your doctor will tell you about the proper procedures for enrolling in this kind of treatment program.
     

Dosing-
For Relief of Pain --Dosage should be adjusted according to the severity of the pain and the response of the patient. Occasionally, it may be necessary to exceed the usual dosage recommended in cases of exceptionally severe pain or in those patients who have become tolerant to the analgesic effects of narcotics. The usual adult dosage is 2.5 mg to 10 mg every 3 or 4 hours as necessary.

Missed dose-
Methadone may be taken as needed. If your doctor has told you to take methadone regularly, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Storage-
To store this medicine:

  • Keep this medication in the container it came in, tightly closed, and out of reach of children.
  • Store it at room temperature and away from excess heat and moisture (not in the bathroom).
  • Throw away any medication that is outdated or no longer needed.
  • Talk to your pharmacist about the proper disposal of your medication.

Side Effects of This Medicine
Although side effects from methadone are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

  • dizziness
  • lightheadedness
  • drowsiness
  • upset stomach
  • vomiting
  • constipation
  • stomach pain
  • rash
  • difficulty urinating

If you experience either of the following symptoms, call your doctor immediately:

  • difficulty breathing
  • fainting

Some commonly used brand names are:

In the U.S.-

  • Dolophine
  • Methadose
 
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Information offered at this Web site by either a lay person or a health professional should not be interpreted as giving a diagnosis or a treatment recommendation. These can only be provided by a physician who has had an opportunity to interact with a patient in person and at length, with access to the patient's previous records and appropriate follow-up.