Methadose (Methadone) Oral: Uses, Side Effects, Dosages

What Is Methadose?

Methadose (methadone) is an opioid prescription medication that can be used as detoxification or maintenance treatment of opioid use disorder in conjunction with appropriate social and medical services. Methadone can also be used for severe chronic (long-term) pain.

Methadone is an opioid agonist. For opioid use disorder, methadone provides similar effects to other opiate medications to prevent withdrawal symptoms. For pain, methadone works by affecting how the central nervous system (CNS) responds to pain. The CNS includes the brain and spinal cord.

Methadone can be habit-forming and result in misuse or dependence. It is classified as a Schedule II controlled substance.

Methadose and its methadone generics are available as a concentrated liquid and a high-strength dispersible (soluble) tablet.

What Is Methadose Used For?

Methadose can be used for the following:

• Detoxification or maintenance treatment of opioid use disorder in conjunction with appropriate social and medical services: Some symptoms of opioid use disorder may include sleeping problems and behavioral changes.
• Severe chronic pain (as generic methadone): In a 2016 survey in the United States, the Centers for Disease Control and Prevention (CDC) estimated that 50 million adults live with chronic pain—with about 20 million adults experiencing high-impact pain. High-impact pain is pain that lasts for three months or longer—with restriction on at least one major activity, such as your ability to perform household chores, go to school, or work outside your home.

How to Take Methadose

Since the dosage and directions might vary per person and the specific methadone product, carefully take the medication according to your healthcare provider’s recommendations.

If you are using methadone to relieve pain, it’s typically taken by mouth every eight to 12 hours. 

If used as part of a detoxification or maintenance program for opioid use disorder, you will also take the dispersible tablet or concentrated liquid by mouth.

Before taking the dispersible tablet, however, you may need to split the tablet along the scored line. You will also need to mix the recommended number of tablets with at least 120 milliliters (mL), or 4 ounces, of fluid—like water, orange juice, or another acidic fruit drink. Make sure to drink this mixture immediately. If you still notice some tablet pieces in your cup, pour a small amount of additional fluid into the cup and drink this mixture.

How to Store Methadose

Since Methadose is a Schedule II controlled substance, you cannot get any refills. A new prescription from your healthcare provider is required if more medication is necessary.

Additionally, secure storage of controlled substances is important to help prevent misuse or accidental consumption. In general, consider storing methadone in a locked cabinet or a similar safe place. Keep Methadose dispersible (soluble) tablets and concentrated liquid dosage forms at room temperature (68–77 degrees F).

If you have leftover or expired medication, disposal through a drug-take-back program is a safe option for getting rid of it. These may be found in your local pharmacies or law enforcement facilities. If no take-back location is available, methadone can be flushed down the toilet, according to the FDA. The agency only recommends this for certain medications.

If you plan to travel with Methadose, become familiar with the regulations of your final destination. Make a copy of your Methadose prescription, and ask for documentation of medical necessity with an official letterhead from your healthcare provider. Also, keep your prescription in its original container or packaging—with your name on it—from the pharmacy.

What Are the Side Effects of Methadose?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Methadose include the following:

• Dizziness
• Light-headedness
• Nausea and vomiting
• Drowsiness or sleepiness
• Sweating

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Methadose has a boxed warning, which is an FDA safety-related warning assigned to a medication, for the following risks:

• Severe or fatal respiratory depression: This risk can be excessive and serious—especially when methadone is combined with other medications that suppress the CNS. Examples of CNS-suppressing medications include alcohol and benzodiazepines like Valium (diazepam).
• Abnormal heart rhythm: Methadone is linked to the side effect of abnormal heart rhythm, which can be serious.
• Overdose: Overdose can happen by accidentally taking one dose, abuse, drug interactions, when initiating treatment, and increasing the dose. Accidental ingestion of Methadose, especially by children, can result in a fatal overdose. Overdose might happen if a high-strength and dispersible (soluble) methadone tablet isn’t mixed with 120 milliliters before taking it. An overdose can also happen if methadone is taken with CYP3A4, 2B6, 2C19, 2C9, or 2D6 inhibitor drugs or discontinuation of CYP3A4, 2B6, 2C19, or 2C9 inducers after taking them together. Ask your pharmacist or healthcare provider if you are unsure if you take any of these medications.
• Opioid use disorder: As a Schedule II controlled medication, methadone is linked to a higher risk of developing opioid use disorder.
• Neonatal opioid withdrawal syndrome (NOWS): Methadone use during pregnancy can result in NOWS, a potentially life-threatening condition in the newborn infant. Your healthcare provider will weigh the risks of NOWS and the benefits of methadone use during pregnancy based on your underlying condition.

Methadone is also linked to the following severe side effects:

• Adrenal insufficiency: In adrenal insufficiency (Addison’s disease), the adrenal glands—small organs sitting on top of the kidneys—aren’t making enough cortisol and sometimes aldosterone. Cortisol and aldosterone are naturally occurring hormones. If you have adrenal insufficiency, you might notice symptoms of dizziness, fainting, muscle weakness, joint pain, and mood changes. Some people might also experience low sexual desire (libido), erectile dysfunction (ED), absence of menstrual periods, or infertility.
• Serotonin syndrome: Serotonin is a naturally occurring chemical. Too much serotonin, however, can lead to a rare but life-threatening condition called serotonin syndrome. Symptoms of serotonin syndrome may include seizures, sweating, and tremors.

Methadone can also cause excessive drowsiness or sleepiness and extremely low blood pressure.

If you experience any of these severe side effects, get medical help right away.

Long-Term Side Effects

With Methadose being a Schedule II controlled substance, long-term use of this medication raises your risk of opioid use disorder. Suddenly stopping long-term methadone, on the other hand, can result in withdrawal symptoms.

In addition to opioid use disorder and withdrawal symptoms, long-term Methadose use may damage your nerves, liver, and brain. Long-term Methadose use is also linked to adrenal insufficiency and negative effects on fertility.

Long-term use of methadone during pregnancy raises the likelihood of neonatal opioid withdrawal syndrome (NOWS). Although NOWS is a life-threatening condition in newborns, it’s treatable.

Dosage: How Much Methadose Should I Take?

Modifications

In some individuals, the body may handle methadone differently. For this reason, your healthcare provider may choose to discontinue your methadone or modify your dosage depending on certain factors.

Pregnancy

Long-term use of methadone during pregnancy raises the risk of neonatal opioid withdrawal syndrome (NOWS), a life-threatening but treatable condition in newborns.

If a newborn has NOWS, the baby might have the following symptoms: irritability, tremors, abnormal sleep patterns, vomiting, and diarrhea. Your baby might also have problems with gaining weight. If you notice these symptoms in your baby, get medical help immediately.

Although NOWS is an expected side effect of long-term methadone use during pregnancy, NOWS is treatable. Not treating opioid use disorder during pregnancy, on the other hand, is linked to preterm birth—with the newborn having a low birth weight. In some cases, untreated opioid use disorder during pregnancy can result in fetal death.

Breastfeeding

While only a low amount of methadone is present in breast milk, there are rare reports of nursing babies experiencing drowsiness, sleepiness, and extremely slow breathing. Therefore, your healthcare provider will want to monitor your baby for these side effects.

Adults Age 65 and Older

While there have been no reported differences between younger adults and adults 65 and older, your healthcare provider may take your age into account when determining your initial dosage, especially if you have decreased liver, kidney, or heart function or other medical considerations.

Liver and Kidney Impairment

People with decreased liver or kidney functioning may need to start on a lower dose of methadone.

Missed Dose

If you’re taking Methadose for pain, take your missed dose as soon as you remember. If it’s already close to your next scheduled dosing time, however, then skip the missed dose and take the following dose at the next scheduled time.

If you missed a Methadose dose for opioid use disorder, however, then skip this missed dose. Take the following dose at the next scheduled dosing time.

Don’t double up and take more methadone to make up for missed doses. Also, try to find ways to consistently remember to take your medication. Missing too many Methadose doses can lead to withdrawal symptoms, which can include:

Overdose: What Happens If I Take Too Much Methadose?

If you accidentally take too much Methadose, you may experience the following symptoms:

• Cold and clammy skin
• Coma
• Extremely slow breathing
• Limp muscles
• Low blood pressure
• Slow heart rate
• Small and pinpoint pupils

If you’re experiencing symptoms of an overdose, use your naloxone medication to reverse the effects of methadone. Your loved ones might need to help you with this.

Then, call 911 right away. While waiting for emergency help, your symptoms might come back. If necessary, naloxone can be used every two to three minutes. Since there are different naloxone products, talk with your pharmacist or healthcare provider for more detailed directions.

Precautions

What Are Reasons I Shouldn’t Take Methadose?

Don’t take Methadose if you have the following:

• Blockage or narrowing of your stomach or intestines
• Severe asthma or asthma flare-up without direct supervision from your healthcare provider
• Severely slow breathing rate
• Severe allergic reaction to methadone or its components

What Other Medications Interact With Methadose?

Use caution with the following medications when taking Methadose:

CYP450-Inhibiting Medications

CYP450 enzymes are proteins in the liver. These proteins help break down and clear out some medications—like methadone—from the body. CYP450-inhibiting medications—like the erythromycin antibiotic—block these proteins from working as well. So, there will be higher amounts of methadone in the body that can raise the likelihood of side effects.

CYP450-Inducing Medications

CYP450-inducing medications—like carbamazepine for seizures—encourage CYP450 enzymes to break down methadone quickly. With a small amount of methadone in the body, methadone is less effective at relieving pain or preventing withdrawal symptoms.

Medications That Affect Heart Rhythm

Cardizem (diltiazem) is an example of a medication that affects heart rhythm. Combining diltiazem or similar medications with methadone is linked to serious side effects of abnormal heart rhythm.

CNS Depressants

CNS depressants—like alcohol or Valium (diazepam)—suppress (slow down) the CNS. Combining these medications with methadone raises your risk of the following serious side effects:

• Low blood pressure
• Slow breathing rate
• Severe drowsiness or sleepiness
• Coma

Mixed Agonist/Antagonist and Partial Agonist Opioids

Mixed agonist/antagonist and partial agonist opioids don’t work the same way as full agonist opioids, such as methadone. In fact, mixed agonist/antagonist and partial agonist opioids can slightly work against a full agonist opioid—like methadone. So, taking mixed agonist/antagonist and partial agonist opioids—like buprenorphine—can cause withdrawal symptoms.

MAOIs

Combining an MAOI with methadone raises your risk of serotonin syndrome, a rare but life-threatening condition. An example MAOI is selegiline, which is used for depression and Parkinson's disease.

This is not a complete list of possible medication interactions with methadone. For more detailed information, speak with your pharmacist or healthcare provider.

What Medications Are Similar?

There are many available medication options to relieve pain. With methadone being an opioid, the following are some examples of other opioid medications:

Compared with most opioids, methadone is one of the longest-acting medications. Methadone usually works well at smaller and less frequent doses. However, it is still an opioid medication posing a risk of developing opioid use disorder.

Since all of these medications are opioids, they are also CNS depressants that suppress (slow down) the CNS. Combining multiple CNS depressants can raise the likelihood of the following serious side effects:

• Extremely slow breathing rate
• Excessive drowsiness or sleepiness
• Coma

Although healthcare providers might prescribe more than one opioid for your symptoms, many try to limit combining multiple opioids. If you have any questions or concerns, speak with your healthcare provider.

How Can I Stay Healthy While Taking Methadose?

Living with pain can be difficult. Work with your healthcare provider to establish reasonable and attainable goals.

In addition to taking Methadose or other medications to relieve pain, your healthcare provider can recommend other strategies that may help. Some recommendations may include:

Addressing opioid use disorder is no small feat. In addition to taking Methadose as part of the detoxification or maintenance program, consider the following general tips:

• Participate in counseling or therapy with a professional therapist or licensed drug counselor.
• Consider talking with a mental health professional to help you develop coping skills that can change how you think, feel, or react to living with opioid use disorder.
• Participate in support groups. Having a strong support network is important.
• Create a regular schedule that also includes routine exercise.
• Find ways to relax and destress. Yoga is a potential option.