Methadone Dose

Medicotion worksheet lo//2011
Gener|c Name]8rand Name

MeLhadone/MeLhadose

Dose] koute] Irequency Crdered
23 mg as 1/2 Lab/Cral/ually
Is th|s route appropr|ate for pat|ent? ?es /no

n|gh A|ert? es ]No Why? AccldenLal overdosage of
oplold analgeslcs has resulLed ln faLallLles 8efore
admlnlsLerlng clarlfy all amblguous orders have second
pracLlLloner lndependenLly check orlglnal order and dose
calculaLlons
n|gh A|ert? es ]No Why?
C|ass|f|cat|on (1herapeut|c]harmaco|og|c)
Cplod analgeslc/Cplold agonlsL

Act|on (therapeut|c effect)
8lnds Lo oplaLe recepLors ln Lhe CnS AlLers Lhe percepLlon
of and response Lo palnful sLlmull whlle produclng
generallzed CnS depresslon
1herapeuLlc LffecL(s) uecrease ln severlLy of paln
Suppresslon of wlLhdrawal sympLoms durlng deLoxlflcaLlon
and malnLenance from heroln and oLher oplolds

Why |s th|s person gett|ng th|s med|cat|on (lndlcaLlon)
Severe paln Suppresses wlLhdrawal sympLoms ln oplold
deLoxlflcaLlon

nome Med|cat|on es ]No If yes dose change? (rev|ous dose
t|me)
unknown
t|me)

harmacok|net|cs (onset peak durat|on metabo||sm)
CnseL 3060 mln eak 90120 mln uuraLlon 412 hr
MeLabollsm Llver
1extbook Dose kange (for ordered route and |nd|cat|on)
C (AdulLs and Chlldren 8 30 kg) Analgeslc20 mg q 68
hr Cplold deLoxlflcaLlon1340 mg once dally or amounL
needed Lo prevenL wlLhdrawal uose may be decreased q
12 days malnLenance dose ls deLermlned on an lndlvldual
basls

Contra|nd|cat|ons]Caut|ous use
PypersenslLlvlLy known alcohol lnLolerance (some oral
soluLlons) ConcurrenL MAC lnhlblLor Lherapy
use CauLlously ln
SLrucLural hearL dlsease concomlLanL dlureLlc use
hypokalemla hypomagnesemla hlsLory of
arrhyLhmla/syncope or oLher rlsk facLors for arrhyLhmlas
ConcurrenL use of drugs LhaL prolong Lhe C1c lnLerval or
are C?3A4 lnhlblLors Pead Lrauma lncreased lnLracranlal
pressure Severe renal hepaLlc or pulmonary dlsease
PypoLhyroldlsm Adrenal lnsufflclency Alcohollsm
undlagnosed abdomlnal paln rosLaLlc hyperplasla or

ureLeral sLrlcLure
Adverse keact|on
Common
confuslon sedaLlon dlzzlness hypoLenslon and
consLlpaLlon

Severe
no sympLoms

1ox|c|ty s|gns]Cverdose Ant|dote?
lf an oplold anLagonlsL ls requlred Lo reverse resplraLory
depresslon or coma naloxone (narcan) ls Lhe anLldoLe
ulluLe Lhe 04mg ampule of naloxone ln 10 mL of 09
naCl and admlnlsLer 03 mL (002 mg) by dlrecL lv push
every 2 mln lor chlldren and paLlenLs welghlng 40 kg
dlluLe 01 mg of naloxone ln 10 mL of 09 naCl for a
concenLraLlon of 10 mcg/mL and admlnlsLer 03 mcg/kg
every 2 mln 1lLraLe dose Lo avold wlLhdrawal selzures
and severe paln
Adverse keact|on
Common

Severe


Adm|n|strat|on arameters ora|]entera| (empty stomach w|th food)
arentera| (compat|b|||ty d||ut|on requ|red and rate)
Lxplaln LherapeuLlc value of medlcaLlon prlor Lo
admlnlsLraLlon Lo enhance Lhe analgeslc effecL
8egularly admlnlsLered doses may be more effecLlve Lhan
prn admlnlsLraLlon Analgeslc ls more effecLlve lf
admlnlsLered before paln becomes severe lor paLlenLs ln
chronlc severe paln Lhe oral soluLlon conLalnlng 3 or 10
mg/3 mL ls recommended on a flxed dose schedule
CoadmlnlsLraLlon wlLh nonoplold analgeslcs may have
addlLlve analgeslc effecLs and may permlL lower doses
MedlcaLlon should be dlsconLlnued gradually afLer long
Lerm use Lo prevenL wlLhdrawal sympLoms
ulskeLLes (dlsperslble LableLs) are Lo be dlssolved and
used for deLoxlflcaLlon and malnLenance LreaLmenL only
- C uoses may be admlnlsLered wlLh food or mllk Lo
mlnlmlze Cl lrrlLaLlon
ulluLe each dose of 10 mg/mL oral concenLraLe wlLh aL
leasL 30 mL of waLer or oLher llquld prlor Lo admlnlsLraLlon
lnsLrucL paLlenL on how and when Lo ask for and Lake paln
medlcaLlon
- lnsLrucL paLlenL Lo Lake meLhadone exacLly as dlrecLed lf
dose ls less effecLlve afLer a few weeks do noL lncrease
dose wlLhouL consulLlng healLh care professlonal
- May cause drowslness or dlzzlness Advlse paLlenL Lo call
for asslsLance when ambulaLlng or smoklng and Lo avold
drlvlng or oLher acLlvlLles requlrlng alerLness unLll response

Lo medlcaLlon ls known
- lnform paLlenL of Lhe poLenLlal for arrhyLhmlas and
emphaslze Lhe lmporLance of regular LCCs
- CauLlon paLlenL noLlfy healLh care professlonal lf slgns of
overdose (dlfflculL or shallow breaLhlng exLreme Llredness
or sleeplness blurred vlslon lnablllLy Lo Lhlnk Lalk or walk
normally and feellngs of falnLness dlzzlness or confuslon)
occur MeLhadone has a prolonged acLlon causlng
lncreased rlsk of overdose
- Advlse paLlenL Lo change poslLlons slowly Lo mlnlmlze
orLhosLaLlc hypoLenslon
- CauLlon paLlenL Lo avold concurrenL use of alcohol or
oLher CnS depressanLs wlLh Lhls medlcaLlon
- Lncourage paLlenL Lo Lurn cough and breaLhe deeply
every 2 hr Lo prevenL aLelecLasls
Assessment needed (pre dur|ng and post)
aln
- Assess Lype locaLlon and lnLenslLy of paln prlor Lo and
12 hr (peak) followlng admlnlsLraLlon When LlLraLlng
oplold doses lncreases of 2330 should be admlnlsLered
unLll Lhere ls elLher a 30 reducLlon ln Lhe paLlenLs paln
raLlng on a numerlc or vlsual analogue scale or Lhe paLlenL
reporLs saLlsfacLory paln rellef A repeaL dose can be safely
admlnlsLered aL Lhe Llme of Lhe peak lf prevlous dose ls
lneffecLlve and slde effecLs are mlnlmal CumulaLlve effecLs
of Lhls medlcaLlon may requlre perlodlc dose ad[usLmenLs
uoses of meLhadone for paLlenLs on meLhadone
malnLenance only prevenL wlLhdrawal sympLoms no
analgesla ls provlded AddlLlonal oplold doses are requlred
for LreaLmenL of paln
- An equlanalgeslc charL (see Lqulanalgeslc uoslng
Culdellnes) should be used when changlng rouLes or when
changlng from one oplold Lo anoLher
- Assess blood pressure pulse and resplraLlons before and
perlodlcally durlng admlnlsLraLlon lf resplraLory raLe ls
10/mln assess level of sedaLlon uose may need Lo be
decreased by 2330 lnlLlal drowslness wlll dlmlnlsh wlLh
conLlnued use
- Assess bowel funcLlon rouLlnely revenLlon of
consLlpaLlon should be lnsLlLuLed wlLh lncreased lnLake of
flulds and bulk and wlLh laxaLlves Lo mlnlmlze consLlpaLlng
effecLs SLlmulanL laxaLlves should be admlnlsLered
rouLlnely lf oplold use exceeds 23 days unless
conLralndlcaLed
- rolonged use may lead Lo physlcal and psychologlcal
dependence and Lolerance 1hls should noL prevenL paLlenL

from recelvlng adequaLe analgesla MosL paLlenLs who
recelve meLhadone for paln do noL develop psychologlcal
dependence rogresslvely hlgher doses may be requlred
Lo relleve paln wlLh longLerm Lherapy
- Assess for hlsLory of sLrucLural hearL dlsease arrhyLhmla
and syncope CbLaln a preLreaLmenL LCC Lo measure C1c
lnLerval and followup LCC wlLhln 30 days and annually
AddlLlonal LCCs recommended lf dose 100 mg/day or lf
paLlenLs have unexplalned syncope or selzures lf C1c
lnLerval ls 430 ms buL 300 ms dlscuss poLenLlal rlsks and
beneflLs wlLh paLlenLs and monlLor more frequenLly lf Lhe
C1c lnLerval 300 ms conslder dlsconLlnulng or reduclng
dose ellmlnaLlng conLrlbuLlng facLors (drugs LhaL promoLe
hypokalemla) or uslng an alLernaLlve Lherapy
Cplold ueLoxlflcaLlon
- Assess paLlenL for slgns of oplold wlLhdrawal (lrrlLablllLy
runny nose and eyes abdomlnal cramps body aches
sweaLlng loss of appeLlLe shlverlng unusually large puplls
Lrouble sleeplng weakness yawnlng) MeLhadone
malnLenance ls underLaken only by federally approved
LreaLmenL cenLers 1hls does noL preclude malnLenance for
addlcLs hosplLallzed for oLher condlLlons and who requlre
Lemporary malnLenance durlng Lhelr care
Lab 1esL ConslderaLlons
- May plasma amylase and llpase levels
keference(s)
uavls urug Culde 12
Lh
LdlLlon pp831834
keference(s)

Medicotion worksheet lo//2011




n|gh A|ert? es ]No Why? n|gh A|ert? es ]No Why?






t|me)

t|me)






Adverse keact|on
Common

Severe


Adverse keact|on
Common

Severe






keference(s)

keference(s)

Methadone Dose

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