Methadone is an option for some chronic pain patients with long-term pain. It should only be prescribed by physicians experienced with its use, typically a pain specialist.
Patient selection: long-term pain AND pain control with an opioid. It should not be used as a first-line treatment of pain.
Parameters:
(1) current daily oral opioid dose in MME
|
Daily Oral MME
|
Daily Oral Methadone Dose in mg
|
|
<= 90
|
MME/4
|
|
90 to 300
|
MME/8
|
|
300 to 500
|
MME/12
|
|
> 500 mg
|
MME/20
|
Dosing: total is divided based on dosing frequency, typically 2-4 times per day. Starting doses ideally should not exceed 30 mg per day.
Methadone is a long-acting opioid, and its analgesic half-life tends to increase with prolonged use.
The duration of analgesia after a dose tends to increase with time. During the first week of therapy, it may be necessary to prescribe a short-acting opioid for breakthrough pain.
Titration should be done slowly. Consider titration 10-15% of total daily dose every 7 days.
Additional instructions:
(1) Do not prescribe with other opioids (except when starting methadone).
(2) Do not prescribe benzodiazepines or other sedatives while on methadone.
(3) Monitor for QT interval prolongation, especially at high doses or when taking another drug that prolongs the QT interval.
