Methadone is a powerful opioid used for maintenance treatment as part of the process of treating opioid dependency. It is also increasingly used for treatment of chronic pain, as it is longer-lasting than many painkillers and may treat neuropathic pain more effectively.
A DOCS Education Member inquires:
I am new to the forum and to DOCS, so I apologize if this has been asked and answered before. I have a patient who is on methadone. Are there any special protocols or cautions to be considered when treating this patient? I understand that methadone is a cytochrome p450 inhibitor and CNS depressant. The patient takes one dose per day in the morning. Thanks!
Dr. Jerome Wellbrock, DOCS Education faculty member, responds:
It was great to meet you this past weekend in SF. I hope you enjoyed the weekend as much as we did teaching the courses. We can treat patients with a history of—or current methadone use, but if they have a significant tolerance to the drugs it may be difficult to reach an adequate level of sedation with oral sedation meds. Usually these patients are better managed with IV Sedation where it is easier to titrate to effect. If you decide to sedate this patient you may want to talk to them about this concern and if they are willing to try then I would give it a go. Thanks for posting and I look forward to seeing you at a future DOCS program.