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The treatment of opioid drug addiction as a narcotic abstinence syndrome suppressant substitution or maintenance therapy. This should be part of a broader treatment programme including regular treatment reviews and must be supervised by specialist services. Prior to starting treatment with opioids, a discussion should be held with patients to put in place a strategy for ending treatment with methadone in order to minimise the risk of addiction and drug withdrawal syndrome see section 4. The decision to maintain a patient on a long-term opioid prescription should be an active decision agreed between the clinician and patient with review at regular intervals usually at least three-monthly, depending on clinical progress.
The dose is adjusted according to the degree of dependence, with the aim of gradual reduction. Providing a dosage schedule is difficult as it is largely subjective based on the addict's reported drug use and a clinical assessment of their dependence. A cautious approach is usually adopted starting at a low dose and following with incremental increases as judged appropriate bearing in mind the general health of the patient. See Sections 4. Usually 5 - 10mg every 6 - 8 hours although doses should be adjusted according to response. In prolonged use it should not be administered more than twice daily.
In the case of the elderly or ill patients, repeated doses should be given with extreme caution due to the long plasma half-life. There may be a greater risk of respiratory depression, with or without any associated renal or hepatic impairment in this age group.
As methadone has not been studied in children, it should not be used in children under the age of 16 years until further data becomes available. In patients with severe liver damage, the dose of methadone should be carefully controlled as there is a risk that methadone might precipitate porto-systemic encephalopathy. Sterile solution for subcutaneous or intramuscular injection. If repeated doses are required the intramuscular route should be used. The intramuscular route is preferred when repeated administration is required. Volumes greater than 2ml 20mg may need to be given in divided doses at different sites.
Opiates may induce the release of endogenous histamine and stimulate catecholamine release. In the case of elderly or ill patients, repeated doses should only be given with extreme caution.
Methadone is a drug of addiction and is controlled under the Misuse of Drugs Act Schedule 2. It has a long half-life and can therefore accumulate. A single dose which will relieve symptoms may, if repeated on a daily basis, lead to accumulation and possible death. Prolonged use of this product may lead to drug dependence addictioneven at therapeutic doses. The risks are increased in individuals with current or past history of substance misuse disorder including alcohol misuse or mental health disorder e.
It is important that patients only use medicines that are prescribed for them at the dose they have been prescribed and do not give this medicine to anyone else. Patients should be closely monitored for s of misuse, abuse, or addiction. The clinical need for continuing opioid substitution therapy should be reviewed regularly. Methadone can produce drowsiness and reduce consciousness although tolerance to these effects can occur after repeated use.
Prior to starting treatment with any opioids, a discussion should be held with patients to put in place a withdrawal strategy for ending treatment with methadone. The decision to maintain a patient on a longterm opioid prescription should be an active decision agreed between the clinician and patient with review at regular intervals usually at least three-monthly, depending on clinical progress. Drug withdrawal syndrome may occur upon abrupt cessation of therapy or dose reduction. When a patient no longer requires therapy, it is advisable to taper the dose gradually to minimise symptoms of withdrawal.
The opioid drug withdrawal syndrome is characterised by some or all of the following: restlessness, lacrimation, rhinorrhoea, yawning, perspiration, chills, myalgia, mydriasis and palpitations. Other symptoms may also develop including irritability, agitation, anxiety, hyperkinesia, tremor, weakness, insomnia, anorexia, abdominal cramps, nausea, vomiting, diarrhoea, increased blood pressure, increased respiratory rate or heart rate.
If women take this drug during pregnancy, there is a risk that their new-born infants will experience neonatal withdrawal syndrome. Due to the slow accumulation of methadone in the tissues, respiratory depression may not be fully apparent for a week or two. Asthma may be exacerbated due to histamine release. Concomitant treatment with other agents with CNS depressant activity is not advised due to the potential for CNS and respiratory depression see also section 4. Methadone should be administered with caution to patients at risk for development of prolonged QT interval, e.
In patients with recognised risk factors for QT prolongation, or in case of concomitant treatment with drugs that have a potential for QT-prolongation, ECG monitoring is recommended prior to methadone treatment, with a further ECG test at dose stabilisation. Female addicts who discover they are pregnant will require specialised care from obstetric and paediatric staff with experience in such management.
Special care should be taken with patients with severe liver damage, as there is a risk that methadone might precipitate porto-systemic encephalopathy or precipitate coma. Opioid analgesics may cause reversible adrenal insufficiency requiring monitoring and glucocorticoid replacement therapy. Symptoms of adrenal insufficiency may include nausea, vomiting, loss of appetite, fatigue, weakness, dizziness, or low blood pressure.
Long-term use of opioid analgesics may be associated with decreased sex hormone levels and increased prolactin. Symptoms include decreased libido, impotence or amenorrhea. Hypoglycaemia has been observed in the context of methadone overdose or dose escalation. Regular monitoring of blood sugar is recommended during dose escalation see section 4. Methadone should be used with great caution in patients with acute alcoholism, convulsive disorders and head injuries. Methadone, as with other opiates, has the potential to increase intracranial pressure especially where it is already raised.
Children under 16 : Even at low doses, methadone is a special hazard to children if ingested accidentally. Children under 6 months, particularly neonates, may be more sensitive to respiratory depression than adults. The drug should be used with caution in elderly or debilitated patients due to its long half-life. It should also be used with caution in patients with hypothyroidism, adrenocortical insufficiency, prostatic hyperplasia, hypotension, shock, biliary tract disorders, inflammatory or obstructive bowel disorders or myasthenia gravis.
Local reactions at the site of injection can occur and therefore these sites should be inspected regularly. Injections may be painful. Because of these risks, concomitant prescribing with these sedative medicines should be reserved for patients for whom alternative treatment options are not possible. The patients should be followed closely for s and symptoms of respiratory depression and sedation.
In this respect, it is strongly recommended to inform patients and their caregivers to be aware of these symptoms see section 4. Interactions are likely with enzyme inhibitors or inducers. Methadone clearance is decreased when co-administered with drugs which inhibit CYP3A4 activity, such as some anti-HIV agents, macrolide antibiotics, cimetidine and azole antifungal agents since the metabolism of methadone is mediated by the CYP3A4 isoenzyme. The concurrent use of MAOIs is contra-indicated see section 4.
Severe CNS excitation, delirium, hyperpyrexia, convulsions or respiratory depression is possible with concurrent use of opiates and MAOIs. With moclobemide, either CNS excitation or depression hypertension or hypotension is possible. Concomitant use of pethidine and other opioid agonist analgesics is not advised because of the potential for additive effects on CNS depression, respiratory depression and hypotension.
Naloxone and naltrexone antagonise the analgesic, CNS and respiratory depressant effects of methadone and can rapidly precipitate withdrawal symptoms see section 4. Similarly, buprenorphine and pentazocine may precipitate withdrawal symptoms.
Concomitant use of other CNS depressants is not advised. Hypnotics including benzodiazepines, chloral hydrate and chlormethiazole and anxiolytics may increase the general depressant effects of methadone. Antipsychotics may enhance the sedative effects and hypotensive effects of methadone. The plasma concentrations of methadone may be increased by fluvoxamine and, to a lesser extent, fluoxetine and theoretically other SSRIs due to decreased methadone metabolism.
There may be increased sedation with tricylic antidepressants. There is an increased risk of ventricular arrhythmias when methadone is given with the CNS stimulant, atomoxetine. Alcohol may enhance the sedative and hypotensive effects of methadone and increase respiratory depression.
Plasma concentrations of methadone may be reduced by the nucleoside reverse transcriptase inhibitor, abacavir, the protease inhibitors, nelfinavir, ritonavir and fosamprenavir which are metabolised by cytochrome P enzyme systems, and the non-nucleoside reverse transcriptase inhibitors, efavirenz and nevirapine, which may interact with a of drugs metabolised in the liver.
Methadone may increase the plasma concentration of the nucleoside reverse transcriptase inhibitor, zidovudine. Reduced plasma levels and increased urinary excretion of methadone can occur with concurrent administration of rifampicin.
Adjustment of the dose of methadone may be necessary. Reduced serum concentrations of ciprofloxacin may occur. Erythromycin theoretically may increase methadone levels due to decreased methadone metabolism.What does 10mg methadone look like
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