Methadone is a common chronic pain management and opioid addiction treatment drug. Starting with the right methadone dose is crucial for fighting the addiction, along with other treatment options.
Methadone is a drug that acts on the brain, causing neuronal changes; hence, it is highly addictive and has side effects. Even though it reduces substance abuse and addiction, it has a high risk of developing addiction.
Therefore, the starting dose and maintenance have to be under strict supervision. We’ll discuss the starting and maximum dose one can take under professional doctor guidance.
Key Factors Impacting Dose Determination
The effective methadone treatment will depend on the current opioid dependence and tolerance. Methadone dose has to be altered individually within the safe range to achieve abstinence from opioids.
As per random clinical trials, the average high dose of 60 mg/d may be effective in reducing heroin use. Sometimes, a maintained lower dose may be enough for optimal results. Individual response is the key to having a dosing schedule, and it won’t be the same for two patients.
Medicines such as anticonvulsant (phenobarbital and carbamazepine) may reduce the impact of methadone. On the other hand, azole antifungals and serotonin reuptake inhibitors increase methadone levels. You should only take the dose recommendations after consultation with the doctor.
Patients who need high methadone dosing:
- High withdrawal episodes in the past
- Prior opioid drug treatment
- Mental issues such as depression and PTSD
- Use of low-purity heroin
Starting Methadone Dose
The dose recommendations are just suggestions and should only be taken after consultation with the doctor. It may take a few sessions to come to the right dose in fighting opioid addiction.
The standard initial dose is 2.5 to 10 mg IV every 8 to 12 hours. You can start the dose at 2.5 mg when considering what is a low dose of methadone. Doctors monitor any signs of respiratory discomfort, depression, and cardiac changes during this initial therapy.
The first 24-72 hours of observations determine the following doses. In the initial stages, doctors may give the doses more frequently for an analgesic or sedation effect. Patients can only do this under medical supervision due to the risk of overdosing.
The maximum dose cannot exceed 20 to 30 milligrams (mg) in a single dose per day. In detoxification and maintenance, the treatment has to be done under 42 CFR (Code of Federal Regulations) Section 8.12. For cessation therapy, doctors must decrease the dose by 10% over 10-14 days.
Typical/Average Methadone Dose
Opioid withdrawal is avoidable with maintenance in the dose. What is the average dose of methadone? The target range is 60 to 120 mg administered orally via pills in most adults. Depending upon the observations, the low initial dose of 10-30 mg can gradually increase to 120 mg. Doctors can increase this by 5-10 mg daily following weekly use.
Exceptions for higher-than-normal dose:
- Patients with high tolerance are receiving methadone maintenance, as it will act as an analgesic.
- Pregnant patients may require fewer or more doses at different intervals to ensure the safety of mom and baby.
Maximum Methadone Dose
In severe addiction cases, the patients may require a high daily dose initially. During initial intervention, the maximum initial dose is set at 30 mg for fighting opium addiction.
It can be adjusted to 40-50 mg for day one as the maximum. This dose should be adjusted throughout the week, considering the withdrawal symptoms every 2 to 5 hours.
Since the lethal dose of methadone is between 200 and 4500 ng/ml, it must not be exceeded even with high degrees of tolerance. If you’re wondering what is the highest dose of methadone, it will be 200-240 ng/ml. The toxic dose starts from 200 ng/ml with accumulated blood methadone at 1.0 mg/l.
Exceeding the maximum dose can result in:
- Respiratory issues
- Constricted pupils
- CNS depression
- Muscle flaccidity
- Hypotension
- Cardiac arrest
- Bradycardia
Methadone Doses for Pain Management
The methadone dose for pain management is started at 2.5 mg every 8 to 12 hours, administered orally via pills. This dose can be altered as needed under a professional doctor’s guidance. The normal adult dose may range from 2.5 to 10 mg, depending on the pain.
Methadone starting dose for pain is only given in acute pain, and the dose must not be exceeded. The methadone max dose for pain for the starting dose is 20 mg per day. In the case of elderly patients, the upper limit is 10 mg per day.
Managing Missed Methadone Doses
If you miss the prescribed dose for adults, chances are your tolerance to the drug will alter. If you go back to a previously high dose by taking two in less than a number of hours, it may result in an overdose.
Missing one dose: If you miss a dose, you may take it within a few hours of missing it. However, if it’s almost time to take another dose, wait until the next scheduled dose. Avoid taking the missed dose in a short period. It is important to maintain the right dose and stay consistent. You can follow the same if you miss two doses in a row.
Missing three doses: For missing three doses in a row, reduce the methadone dose by 25% to compensate for the tolerance reduction.
Missing four doses: If you have skipped four doses in a row, the tolerance will decrease to 50%. Thus, the dose should be adjusted accordingly.
After this, a gradual increase in dose should be considered in the following days to reach the previous levels of the dose. After missing more than four doses, you must start at the initial dose right from the beginning of the treatment.
Summary
Each patient’s methadone dose will differ as per the tolerance level, medical history, and age. It is crucial to work with a doctor and follow the prescribed dose. In addition, attending counseling sessions can be another step toward recovery. We advise consulting with a qualified healthcare professional for any questions or concerns regarding methadone treatment. Visit the nearest methadone clinic for help.
