Methadone - Revision history

Aidan at 17:28, 27 September 2024

2024-09-27T17:28:29Z

← Older revision		Revision as of 17:28, 27 September 2024
Line 9:		Line 9:
	==== META-PHI Protocol for Fentanyl ====		==== META-PHI Protocol for Fentanyl ====

			* From [[CiteRef::bromley2021me]]
	* From <ref>Bromley L, Kahan M, Regenstreif L, Srivastava A, Wyman J. Methadone treatment for people who use fentanyl: Recommendations. Toronto, ON: META:PHI; 2021. www.metaphi.ca</ref>
	* May be considered in patients who are not high risk for adverse events (acute respiratory illness, sedating medications, liver or renal failure, or uncertain opioid tolerance)		* May be considered in patients who are not high risk for adverse events (acute respiratory illness, sedating medications, liver or renal failure, or uncertain opioid tolerance)
	** In these patients, start at 10 to 20 mg and titrate 10 mg every 3 to 5 days		** In these patients, start at 10 to 20 mg and titrate 10 mg every 3 to 5 days

Aidan at 17:07, 27 September 2024

2024-09-27T17:07:00Z

← Older revision		Revision as of 17:07, 27 September 2024
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	==== META-PHI Protocol for Fentanyl ====		==== META-PHI Protocol for Fentanyl ====

	* From <ref>Bromley L, Kahan M, Regenstreif L, Srivastava A, Wyman J. Methadone treatment for people who use		* From <ref>Bromley L, Kahan M, Regenstreif L, Srivastava A, Wyman J. Methadone treatment for people who use fentanyl: Recommendations. Toronto, ON: META:PHI; 2021. www.metaphi.ca</ref>

	fentanyl: Recommendations. Toronto, ON: META:PHI; 2021. www.metaphi.ca</ref>
	* May be considered in patients who are not high risk for adverse events (acute respiratory illness, sedating medications, liver or renal failure, or uncertain opioid tolerance)		* May be considered in patients who are not high risk for adverse events (acute respiratory illness, sedating medications, liver or renal failure, or uncertain opioid tolerance)
	** In these patients, start at 10 to 20 mg and titrate 10 mg every 3 to 5 days		** In these patients, start at 10 to 20 mg and titrate 10 mg every 3 to 5 days

Aidan: /* Initiation */

2022-07-27T01:20:21Z

Initiation

@@ Line 6: / Line 6: @@
 ==Dosing==
 ===Initiation===
 ====St. Paul's Protocol====
 {| class="wikitable"

Aidan at 00:33, 11 February 2021

2021-02-11T00:33:29Z

← Older revision		Revision as of 00:33, 11 February 2021
Line 1:		Line 1:
			== Background ==

			* Full opioid agonist
			* Serum levels peak 2 to 3 hours for methadone

	==Dosing==		==Dosing==
	===Initiation===		===Initiation===
Line 52:		Line 57:
	\|}		\|}

	=== CPSO Guidelines ===		===CPSO Guidelines===

	* Patients who miss 3 or more doses must be assessed in person before getting a new prescription		*Patients who miss 3 or more doses must be assessed in person before getting a new prescription
	* Patients who miss a dose must remain on that dose for another 3 days before considering titration		*Patients who miss a dose must remain on that dose for another 3 days before considering titration
	* No dose increases without assessing patient		*No dose increases without assessing patient
	* Patients on [[benzodiazepines]] must start at lower doses and should generally not receive carries		*Patients on [[benzodiazepines]] must start at lower doses and should generally not receive carries
	* Patients should not receive additional [[opioids]] except for acute pain management		*Patients should not receive additional [[opioids]] except for acute pain management
	* Obtain an ECG before increasing the dose above 120 mg		*Obtain an ECG before increasing the dose above 120 mg

	[[Category:Opioid substitution therapy]]		[[Category:Opioid substitution therapy]]

Aidan at 04:42, 12 January 2021

2021-01-12T04:42:45Z

← Older revision		Revision as of 04:42, 12 January 2021
Line 1:		Line 1:
	== Dosing ==		==Dosing==
	=== Initiation ===		===Initiation===
	==== St. Paul's Protocol ====		====St. Paul's Protocol====
	{\| class="wikitable"		{\| class="wikitable"
	! Day !! Dose		!Day!!Dose
	\|-		\|-
	! colspan=2 \| Protocol 1		! colspan="2" \|Protocol 1
	\|-		\|-
	\| 1 \|\| rowspan=3 \| 20 mg TID or 15 mg QID + 3h post-dose assessment		\|1\|\| rowspan="3" \|20 mg TID or 15 mg QID + 3h post-dose assessment
	\|-		\|-
	\| 2		\|2
	\|-		\|-
	\| 3		\|3
	\|-		\|-
	\| 4 \|\| 70 mg daily + 10 mg q3h prn x2 doses		\|4\|\|70 mg daily + 10 mg q3h prn x2 doses
	\|-		\|-
	\| 5 \|\| Day 4 dose, titrated every 3-4 days		\|5\|\|Day 4 dose, titrated every 3-4 days
	\|-		\|-
	! colspan=2 \| Protocol 2		! colspan="2" \|Protocol 2
	\|-		\|-
	\| 1 \|\| rowspan=3 \| 30 mg TID + 10 mg q3h prn x3 doses + 3h post-dose assessment		\|1\|\| rowspan="3" \|30 mg TID + 10 mg q3h prn x3 doses + 3h post-dose assessment
	\|-		\|-
	\| 2		\|2
	\|-		\|-
	\| 3		\|3
	\|-		\|-
	\| 4 \|\| 70 mg daily + 10 mg q3h prn x2 doses		\|4\|\|70 mg daily + 10 mg q3h prn x2 doses
	\|-		\|-
	\| 5 \|\| Day 4 dose, titrated every 3-4 days		\|5\|\|Day 4 dose, titrated every 3-4 days
	\|}		\|}

	==== St. Michael's Protocol ====		====St. Michael's Protocol====

	* Start methadone 40 mg and titrate up by 10 mg daily until 70 mg, then hold for 3 days		*Start methadone 40 mg and titrate up by 10 mg daily until 70 mg, then hold for 3 days

	{\| class="wikitable"		{\| class="wikitable"
	! Day !! Methadone !! Morphine		!Day!!Methadone!!Morphine
	\|-		\|-
	\| 1 \|\| 40 mg \|\| 30-50 mg po q2h while awake + 30-50 mg po q3h prn for mild withdrawal + 20 mg IM for severe withdrawal		\|1\|\|40 mg\|\|30-50 mg po q2h while awake + 30-50 mg po q3h prn for mild withdrawal + 20 mg IM for severe withdrawal
	\|-		\|-
	\| 2 \|\| 50 mg at 10:00 \|\| As above + 50% of total Day 1 requirements as Kadian at 16:00		\|2\|\|50 mg at 10:00\|\|As above + 50% of total Day 1 requirements as Kadian at 16:00
	\|-		\|-
	\| 3 \|\| 60 mg at 10:00 \|\| Kadian Day 2 dose at 10:00; switch standing morphine to prn		\|3\|\|60 mg at 10:00\|\|Kadian Day 2 dose at 10:00; switch standing morphine to prn
	\|-		\|-
	\| 4 \|\| 70 mg at 10:00 \|\| Kadian Day 2 dose + 50% of additional morphine Day 3 dose; continue prn		\|4\|\|70 mg at 10:00\|\|Kadian Day 2 dose + 50% of additional morphine Day 3 dose; continue prn
	\|-		\|-
	\| 5 \|\| 70 mg at 10:00 \|\| Kadian Day 4 dose		\|5\|\|70 mg at 10:00\|\|Kadian Day 4 dose
	\|-		\|-
	\| 6 \|\| 70 mg at 10:00 \|\| Kadian Day 5 dose + 50% of additional morphine Day 5 dose		\|6\|\|70 mg at 10:00\|\|Kadian Day 5 dose + 50% of additional morphine Day 5 dose
	\|-		\|-
	\| 7 \|\| 85 mg at 10:00 \|\| Kadian Day 6 dose		\|7\|\|85 mg at 10:00\|\|Kadian Day 6 dose
	\|}		\|}

			=== CPSO Guidelines ===

			* Patients who miss 3 or more doses must be assessed in person before getting a new prescription
			* Patients who miss a dose must remain on that dose for another 3 days before considering titration
			* No dose increases without assessing patient
			* Patients on [[benzodiazepines]] must start at lower doses and should generally not receive carries
			* Patients should not receive additional [[opioids]] except for acute pain management
			* Obtain an ECG before increasing the dose above 120 mg

	[[Category:Opioid substitution therapy]]		[[Category:Opioid substitution therapy]]

Aidan: /* St. Michael's Protocol */

2020-07-27T14:22:17Z

St. Michael's Protocol

← Older revision		Revision as of 14:22, 27 July 2020
Line 32:		Line 32:
	==== St. Michael's Protocol ====		==== St. Michael's Protocol ====
	* Start methadone 40 mg and titrate up by 10 mg daily until 70 mg, then hold for 3 days		* Start methadone 40 mg and titrate up by 10 mg daily until 70 mg, then hold for 3 days
	* Increase [[Kadian]] every 2 days based on 50% of immediate-release [[morphine]] requirements

	{\| class="wikitable"		{\| class="wikitable"

Aidan: Created page with "== Dosing == === Initiation === ==== St. Paul's Protocol ==== {| class="wikitable" ! Day !! Dose |- ! colspan=2 | Protocol 1 |- | 1 || rowspan=3 | 20 mg TID or 15 mg QID + 3..."

2020-07-05T13:53:09Z

Created page with "== Dosing == === Initiation === ==== St. Paul's Protocol ==== {| class="wikitable" ! Day !! Dose |- ! colspan=2 | Protocol 1 |- | 1 || rowspan=3 | 20 mg TID or 15 mg QID + 3..."

New page

== Dosing ==
=== Initiation ===
==== St. Paul's Protocol ====
{| class="wikitable"
! Day !! Dose
|-
! colspan=2 | Protocol 1
|-
| 1 || rowspan=3 | 20 mg TID or 15 mg QID + 3h post-dose assessment
|-
| 2
|-
| 3
|-
| 4 || 70 mg daily + 10 mg q3h prn x2 doses
|-
| 5 || Day 4 dose, titrated every 3-4 days
|-
! colspan=2 | Protocol 2
|-
| 1 || rowspan=3 | 30 mg TID + 10 mg q3h prn x3 doses + 3h post-dose assessment
|-
| 2
|-
| 3
|-
| 4 || 70 mg daily + 10 mg q3h prn x2 doses
|-
| 5 || Day 4 dose, titrated every 3-4 days
|}

==== St. Michael's Protocol ====
* Start methadone 40 mg and titrate up by 10 mg daily until 70 mg, then hold for 3 days
* Increase [[Kadian]] every 2 days based on 50% of immediate-release [[morphine]] requirements

{| class="wikitable"
! Day !! Methadone !! Morphine
|-
| 1 || 40 mg || 30-50 mg po q2h while awake + 30-50 mg po q3h prn for mild withdrawal + 20 mg IM for severe withdrawal
|-
| 2 || 50 mg at 10:00 || As above + 50% of total Day 1 requirements as Kadian at 16:00
|-
| 3 || 60 mg at 10:00 || Kadian Day 2 dose at 10:00; switch standing morphine to prn
|-
| 4 || 70 mg at 10:00 || Kadian Day 2 dose + 50% of additional morphine Day 3 dose; continue prn
|-
| 5 || 70 mg at 10:00 || Kadian Day 4 dose
|-
| 6 || 70 mg at 10:00 || Kadian Day 5 dose + 50% of additional morphine Day 5 dose
|-
| 7 || 85 mg at 10:00 || Kadian Day 6 dose
|}

[[Category:Opioid substitution therapy]]
[[Category:Medications]]
[[Category:Addiction medicine]]