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