methadone (Dolophine; Methadone HCl Intensol; Methadose; Methadose Sugar-Free)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: Methadone
BRAND NAME: Dolophine; Methadone HCl Intensol; Methadose; Methadose Sugar-Free
DRUG CLASS AND MECHANISM: 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.
GENERIC AVAILABLE: Yes
STORAGE: 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.
PRESCRIBED FOR: 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.
DOSING: 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 10-40 mg given every 6-12 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 10mg 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.
DRUG INTERACTIONS: Methadone when taken with drugs that slow brain function, such as alcohol and barbiturates (phenobarbital), can increase the effects of these drugs. Since methadone causes constipation, taking antidiarrheal medications such as diphenoxylate and atropine (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.
Medically Reviewed by a Doctor on 4/16/2014
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