Methadone
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Synthetic, highly lipid soluble, mu opioid receptor agonist. with additional NMDA antagonist activity. Pharmacokinetic profile following an intravenous bolus is characterised by a rapid effect site equilibration (~8min), followed by a prolonged elimination half life.

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Oct 17, 2011
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Intraoperative intravenous methadone improves postoperative pain scores and reduces postoperative opiod requirements in spinal surgery. A&A 2011 journals.lww.com/anesthes...

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Apr 28, 2017
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Methadone is a good option for chronic pain management during pregnancy because NICU are familiar with the management of neonates to mothers on methadone. If they are placed on oxycodone or an opioid patch, these are more likely to be missed by the neonatologists.

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Oct 03, 2011
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To convert methadone dose to morphine dose: Daily oral methadone to daily oral morphine (Multiply by 4). Daily oral morphine to IV morphine (divide by 3). Take 50% cross-tolerance into account (divide by 2). refl.in/4l

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Aug 19, 2011
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Compartment saturation in adults occurs after an intravenous dose of ~20mg. #ref #improve

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Oct 17, 2011
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Dosing tips as per Dr Richard Barnes

#vicanzcaasm2014

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Jul 26, 2014
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To convert oral methadone to IV methadone it is a 2:1 Oral:IV conversion, due to the relatively high oral bioavailability. To convert IV methadone to oral methadone it is a 1:1 IV:oral conversion (this is to prevent inadvertant overdose) refl.in/4p p217

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Aug 19, 2011
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Ceasing enzyme inducing drugs (eg carbemazepine)
turns patients into slow metabolizers (3A4 pathway). The usual methadone dose can therefore become too high. refl.in/methadone

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Oct 02, 2011
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Because of its long half-life, withholding methadone for one or even two days is unlikely to result in withdrawal refl.in/methadone

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Jul 10, 2011
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If day surgery, recommence usual methadone dose immediately. Prescribe additional analgesic for pain control. refl.in/methadone

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Oct 02, 2011
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If inpatient NBM/NPO for >48hrs, administer analgesic opiate + additional opiate to prevent withdrawal. If >5days NBM, consult primary prescriber on restarting dose. refl.in/methadone

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Jul 10, 2011
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If inpatient, NBM/NPO <48hrs, analgesic (eg PCA), then recommence at usual dose. Long half life means withdrawal <48hrs unlikely. refl.in/methadone

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Jul 09, 2011
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In acute pain setting continue at normal dose. If reported dose is questionable, give patient half reported dose and repeat in 8hrs if needed and patient is not sedated from previous dose.

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Jul 10, 2011
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Patients on larger doses of methadone may be "opioid tolerant". When undergoing procedures likely to result in moderate to severe pain, intraoperative ketamine is an option to reduce opiate requirements. refl.in/lt

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Apr 20, 2012
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Effect site equilibration time is short (8min t1/2) I.e. similar to fentanyl.

Elimination half-life however is very long.

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Jul 26, 2014
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Methadone may have NMDA antagonist properties.

#vicanzcaasm2014

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Jul 26, 2014
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Product information refl.in/mn

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Dec 13, 2011
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Review article: Perioperative pain management of
patients on methadone therapy. refl.in/methadone

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May 18, 2011
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