Methadone

Abstract Methadone, a highly effective but tightly regulated treatment for opioid use disorder, reduces morbidity and mortality in patients with this condition. Methadone has a unique pharmacologic profile and is metabolized variably by patients, resulting in a wide range of maintenance doses. An adequate maintenance dose should eliminate opioid withdrawal symptoms for at least 24 hours and abate opioid cravings, allowing the patient to function unimpaired in daily activities. Furthermore, optimal dosing minimizes side effects, which commonly include sedation, nausea, constipation, and sweating. Clinically significant QTc prolongation is rare, but patients with serious cardiac risk factors should be monitored by EKG. While there are no absolute contraindications to methadone, it is important to consider patient preference, ability to dose regularly in clinic, co-morbid medical conditions, and drug–drug interactions. Finally, clinicians and patients alike must remain cognizant of additive respiratory depression and CNS effects when methadone is combined with alcohol and sedative-hypnotics.