Methadone: Difference between revisions
From IDWiki
No edit summary |
No edit summary |
||
| 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=== |
| − | * |
+ | *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]] |
||
Revision as of 20:33, 10 February 2021
Background
- Full opioid agonist
- Serum levels peak 2 to 3 hours for methadone
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
