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Pain Management

Indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Buy Methadone Physeptone online in New Zealand and Australia

Opioid-naive patients: 2.5 mg PO q8-12hr; titrate slowly with dose increases no more frequent than every 3-5 days

Conversion from parenteral methadone to oral methadone

• 1:2 Parenteral-to-PO ratio: 5 mg parenteral = 10 mg PO

Conversion from other oral opioids to oral or intravenous methadone

• Total daily baseline oral estimated daily oral and intravanous methadone requirement as percent of morphine equivalent dose
• < 100 mg morphine equivalent dose: Administer 20% to 30% oral methadone or 10-15% IV methdone as percent of morphine equivalent dose
• 100-300 mg morphine equivalent dose: Administer 10% to 20% oral methadone or 5-10% IV methadone as percent of morphine equivalent dose
• 300-600 mg morphine equivalent dose: administer 8% to 12% oral methadone or 4-6% IV methadone as percent of morphine equivalent dose
• 600-1,000 mg morphine equivalent dose: administer 5% to 10% oral methadone or 3-5% IV methadone as percent of morphine equivalent dose
• > 1,000 mg morphine equivalent dose: Administer < 5 % oral methadone or <3% IV methadone as percent of morphine equivalent dose
• For patients on a single opioid, sum the current total daily dose of the opioid, convert it to a morphine equivalent dose according to specific conversion factor for that specific opioid, then multiply the Morphine equivalent dose by the corresponding percentage in the above conversion description to calculate the approximate oral and IV methadone daily dose; divide the total daily methadone dose derived from the conversion description above to reflect the intended dosing schedule (i.e., for administration every 8 hours, divide total daily methadone dose by 3)
• For patients on a regimen of more than one opioid, calculate the approximate oral methadone dose for each opioid and sum the totals to obtain the approximate total methadone daily dose. Divide the total daily methadone dose derived from the conversion description above to reflect the intended dosing schedule (i.e., for administration every 8 hours, divide total daily methadone dose by 3). Buy Methadone Physeptone online in New Zealand and Australia

Parenteral morphine to intravenous methadone conversion for chronic administration

• Total daily baseline parenteral estimated daily parenteral methadone requirement as percent of total daily morphine dose
• 10-30 mg total daily baseline parenteral morphine dose: Administer 40-66% parenteral methadone as percent of morphine dose
• 30-50 mg total daily baseline parenteral morphine dose: Administer 27-66% parenteral methadone as percent of morphine dose
• 50-100 mg total daily baseline parenteral morphine dose: Administer 22-50% parenteral methadone as percent of morphine dose
• 100-200 mg total daily baseline parenteral morphine dose: Administer 15-34% parenteral methadone as percent of morphine dose
• 200-500 mg total daily baseline parenteral morphine dose: Administer 10% to 20% parenteral methadone as percent of morphine dose
• The total daily methadone dose derived from the conversion calculations above may be divided to reflect the intended dosing schedule (i.e., for administration every 8 hours, divide total daily methadone dose by 3)
• Methadone dosing should not be based solely on these methadone conversion calculations; dose titration methods should always be individualized to account for the patient’s prior opioid exposure, general medical condition, concomitant medication, and anticipated breakthrough medication use; the endpoint of titration is achievement of adequate pain relief, balanced against tolerability of opioid side effects; if a patient develops intolerable opioid related side effects, the methadone dose, or dosing interval, may need to be decreased; for patients on a regimen of fixed-ratio opioid/non-opioid analgesic products, use only the opioid component of these products in the conversion; always round the dose down, if necessary, to the appropriate methadone tablet or IV formulation strength(s) available. Buy Methadone Physeptone online in New Zealand and Australia

Opioid-tolerant patients

• Discontinue all other around-the-clock opioids
• Substantial interpatient variability, see prescribing information for guidance

Opioid-tolerant definition

• Patients who are opioid tolerant are those receiving, for 1 week or longer, at least 60 mg/day PO morphine, 25 mcg/hr transdermal fentanyl, 30 mg/day PO oxycodone, 8 mg/day PO hydromorphone, 25 mg/day PO oxymorphone, or an equianalgesic dose of another opioid
• Use of higher starting doses in patients who are not opioid tolerant may cause fatal respiratory depression

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Detoxification

20-30 mg PO once daily or minimum dosage necessary to suppress withdrawal; may be titrated to 40 mg/day in divided doses and continued for 2-3 days, then decreased 20% daily as tolerated

Dosing Modifications

Renal impairment (CrCl <10mL/min): 50-75% of normal dose

Hepatic impairment: Not recommended in severe liver disease:

Dosing Considerations

Do not abruptly discontinue methadone in a physically dependent patient. Buy Methadone Physeptone online in New Zealand and Australia

Limitations of use

• Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, and because of the greater risks of overdose and death with extended-release opioid formulations, reserve for patients whom alternative treatment options (eg, nonopioid analgesics or immediate-release opioids) are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient management of pain
• Not indicated for acute pain or as a PRN analgesic

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Access to naloxone for opioid overdose

• Assess need for naloxone upon initiating and renewing treatment

• Consider prescribing naloxone

  • Based on patient’s risk factors for overdose (eg, concomitant use of CNS depressants, a history of opioid use disorder, prior opioid overdose); presence of risk factors should not prevent proper pain management
  • Household members (including children) or other close contacts at risk for accidental ingestion or overdose

• Consult patients and caregivers on the following:

  • Availability of naloxone for emergency treatment of opioid overdose
  • Ways differ on how to obtain naloxone as permitted by individual state dispensing and prescribing requirements or guidelines (eg, by prescription, directly from a pharmacist, as part of a community-based program). Buy Methadone Physeptone online in New Zealand and Australia