Methadone: Difference between revisions
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+ | ==Dosing== |
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+ | ===Initiation=== |
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+ | ====St. Paul's Protocol==== |
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+ | !Day!!Dose |
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+ | ! colspan="2" |Protocol 1 |
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+ | |1|| rowspan="3" |20 mg TID or 15 mg QID + 3h post-dose assessment |
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+ | |2 |
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+ | |3 |
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+ | |4||70 mg daily + 10 mg q3h prn x2 doses |
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+ | |5||Day 4 dose, titrated every 3-4 days |
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+ | ! colspan="2" |Protocol 2 |
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+ | |1|| rowspan="3" |30 mg TID + 10 mg q3h prn x3 doses + 3h post-dose assessment |
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+ | |2 |
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+ | |3 |
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+ | |4||70 mg daily + 10 mg q3h prn x2 doses |
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+ | |5||Day 4 dose, titrated every 3-4 days |
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− | ==== |
+ | ====St. Michael's Protocol==== |
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− | * |
+ | *Start methadone 40 mg and titrate up by 10 mg daily until 70 mg, then hold for 3 days |
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+ | !Day!!Methadone!!Morphine |
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+ | |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 |
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+ | |2||50 mg at 10:00||As above + 50% of total Day 1 requirements as Kadian at 16:00 |
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+ | |3||60 mg at 10:00||Kadian Day 2 dose at 10:00; switch standing morphine to prn |
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+ | |4||70 mg at 10:00||Kadian Day 2 dose + 50% of additional morphine Day 3 dose; continue prn |
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+ | |5||70 mg at 10:00||Kadian Day 4 dose |
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+ | |6||70 mg at 10:00||Kadian Day 5 dose + 50% of additional morphine Day 5 dose |
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+ | |7||85 mg at 10:00||Kadian Day 6 dose |
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+ | === CPSO Guidelines === |
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+ | * Patients who miss 3 or more doses must be assessed in person before getting a new prescription |
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+ | * Patients who miss a dose must remain on that dose for another 3 days before considering titration |
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+ | * No dose increases without assessing patient |
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+ | * Patients on [[benzodiazepines]] must start at lower doses and should generally not receive carries |
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+ | * Patients should not receive additional [[opioids]] except for acute pain management |
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+ | * Obtain an ECG before increasing the dose above 120 mg |
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[[Category:Opioid substitution therapy]] |
[[Category:Opioid substitution therapy]] |
Revision as of 00:42, 12 January 2021
Dosing
Initiation
St. Paul's Protocol
Day | Dose |
---|---|
Protocol 1 | |
1 | 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 |
Protocol 2 | |
1 | 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
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 |
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
References
- ^ Lisa Bromley, Meldon Kahan, Leonora Regenstreif, Anita Srivastava, Jennifer Wyman. Methadone treatment for people who use fentanyl: Recommendations. META:PHI; 2021.