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- Patients who are opioid-tolerant are those receiving, for 1 week or longer, at least 60 mg/day PO morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg/day PO oxymorphone, or an equianalgesic dose of another opioid
- Use of higher starting doses in patients who are not opioid-tolerant may cause fatal respiratory depression
GUIDANCE ON USE OF METHADONE Drug details Synthetic strong opioid with mixed properties
Useful for severe (and possibly neuropathic) pain, and for cough
Also used in the treatment of opioid addiction
Renal and hepatic impairment does not affect clearance
Onset of action 30 min PO methadone tab 5mg.
Duration of action 4-5 hrs for first dose PO, 100% Pure Heroin 6-12 hrs for subsequent doses, sometimes more Indications
Moderate-severe pain, with intolerance of, 5mg methadone withdrawal or lack of response to, other opioids
Particularly appropriate for pain, 5mg methadone equivalent with a neuropathic element Cautions
Accumulates in tissues when given repeatedly, Methadone 10mg making withdrawal and conversion to other opioids difficult
Conversion from other opioids and individual patient response difficult to predict Side effects
• Like other opioids, but less sedating than morphine Administration for cough Methadone linctus (2mg/5ml) – give 1-2mg every 4-6h rs as required, decreasing to bd on prolonged use.
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