Generic Name:

Methadone

Trade Name:

Action:

Opiate Analgesic

Indications:

Analgesia: “Restricted Use” Pain and/or Palliative Services approval is required

Maintenance Therapy

Administration Guidelines

Usual Dosage Range and Route:

For continuous infusions :

For opioid naïve patients: Up to 5 mg/hr for patients starting on therapy titrated to patient's response

For Intermittent therapy :

Opioid Naïve Patients : Nurses may IVP doses up to 5 mg over 2 minutes

Opioid Tolerant Patients : Nurses may IVP doses up to 10 mg over 2 minutes

Standard Concentrations:

 50mg/50 ml (1mg/ml) Bag

500mg /50 ml (10mg/ml) Bag Note: High Concentration

For Intermittent therapy :

5mg/5mL(1mg/mL) vial

Doses > 10 mg will be mixed in 100 mL bag and delivered via an infusion device  

Special Considerations:

-Slow titration and frequent monitoring is recommended. (Refer to Intravenous Methadone Policy: Patient Monitoring )

- Rapid injection can cause increased side effects

- Tolerance may result in higher dosage requirements

- Accumulation can occur 36-48 hours after initiation of dosing, necessitating dosage/interval adjustment

-EKG evaluation is recommended in patients with potential QT prolongation from conduction abnormalities, drug interactions, electrolyte abnormalities, and/or high doses of methadone.

- For patients maintained on oral methadone and unable to tolerate oral therapy may convert (2:1) oral to IV therapy and consider consulting Addition Services for appropriate management recommendations.

-A stimulant laxative bowel regimen should be started for all patients receiving Methadone.

Precautions and Side Effects:

- Respiratory depression

- Ileus, constipation, nausea, vomiting

- Hypotension

- CNS depression-dysphoria

-Agitation, seizures

-QT Prolongation, Torsade De Pointes

- Tachycardia, Bradycardia

Subject :

Adult General Care Guidelines

Title:

Methadone Intravenous

Approved By and Date:

Nursing Practice Committee 03/2009

MESAC 2/09

Reviewed By and Date: