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Methadone prescribing

Key sources
The following summarized guidelines for the evaluation and management of methadone prescribing are prepared by our editorial team based on guidelines from the American Pain Society (APS/CPDD/HRS 2014).
1

Guidelines

1.Diagnostic investigations

Behavioral risk evaluation: perform an individualized medical and behavioral risk evaluation in patients in whom methadone therapy is being considered, in order to assess the risks and benefits of therapy, given methadone's specific pharmacologic properties and adverse effect profile.
B
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  • Baseline ECG (patients at risk for QTc prolongation)

  • Baseline ECG (patients not at risk for QTc prolongation)

  • Urine drug testing

2.Medical management

General principles: avoid prescribing methadone in patients with a baseline QTc interval > 500 ms.
D
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  • Methadone therapy

  • Buprenorphine therapy

3.Specific circumstances

Pregnant patients: monitor neonates born to mothers receiving methadone for neonatal abstinence syndrome, and treat when present.
B

4.Patient education

General counseling: educate patients in whom methadone therapy is being considered regarding the indications for treatment, goals of therapy, availability of alternative therapies, potential adverse effects associated with methadone, and specific plans for monitoring therapy, adjusting doses, reducing the risk of adverse effects and managing them.
B

5.Follow-up and surveillance

Follow-up clinical assessment
Schedule a follow-up face-to-face or telephone assessment within 3-5 days after initiating methadone, and within 3-5 days after each dose increase.
B
Monitor patients receiving methadone for common opioid adverse effects, and manage adverse effects as part of routine therapy.
B

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  • Follow-up ECG