A Simple Guide to Methadone Dosing

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Fareed, A., Casarella, J., Roberts, M., Sleboda, M., Amar, R., Vayalapalli, S., & Drexler, K. (2009). High dose versus moderate dose methadone maintenance: is there a better outcome?. Journal of addictive diseases28(4), 399–405. https://doi.org/10.1080/10550880903183042

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The goal of methadone dosing is to reduce cravings and stop withdrawal symptoms without giving off the high. Dosages are constantly adjusted and monitored to be most effective for each patient, per the federal opioid treatment standards.

Category: Addiction Medicine > Methadone

Table of Contents

Methadone Starting Dose

The standard induction dose of methadone is 20 mg, always given under direct medical supervision.

Patients are observed by the medical staff for 2-3 hours to assess the reaction to the initial dose. If patients have opioid withdrawal symptoms, then an additional 5-10 mg of methadone should be given and the patient should continue to be monitored.

Methadone is usually given as an oral liquid. Methadose is the most common brand.

Are you looking to start methadone treatment?

Methadone Standard Dose

The initial dose(s) of methadone can be increased by 5-10 mg every few days as-needed to reduce opioid cravings. On average, the most effective methadone dose is 60-120 mg per day.
The four phases of methadone dosing chart

Less commonly, some patients are stabilized for low dose maintenance, which is 20 to 60 mg.

How do you determine methadone dosage?

Tolerance determines the appropriate methadone dose. Tolerance is shaped by the length of time using opioids, the amount of opioids used, the type of opioid used and how a person’s body reacts to opioids. The way to measure tolerance is by monitoring the reaction to each dose of methadone.

Patients are monitored when they come in and after every dose. If there is intoxication or seduction, then the dose likely should be lowered. If there are significant withdrawal symptoms, then the dose likely should be increased.

A high dose of methadone during stabilization could be considered anything over 100 mg. Though, 40 mg would be considered a very high initial dose of methadone.

The recommended maximum daily dose of methadone is 120 mg.

For those that have never used opioids, 50 mg is estimated to be a lethal dose. But, those with the highest tolerance to opioids may be able to handle over three times this amount. 

Yes, methadone is a full opioid and too high of a dose can lead to overdose. Because of this risk, methadone can only be administered by Opioid Treatment Program (OTP) programs that are monitored by SAMHSA and the DEA.

A dose of methadone generally lasts 24 hours. Though, it can metabolize quicker when pregnant or when patients are on medications that speed up their metabolism. Peak and trough levels can be tested. And, if required, split dosing may be appropriate where the patient gets medication both in the mornings and evenings.

Methadone can be used to detox from opioids without the intent to remain on the medication long-term. However, buprenorphine is a more common choice for opioid detox.

To use methadone for opioid detox, start the dosing at 10-20 mg. The dose should be adjusted based on the withdrawal symptoms and can then be reduced by 1-2 mg per day. Patients may have mild withdrawal symptoms for several weeks after stopping methadone.

Missing a Dose of Methadone

Methadone requires daily dosing.

Missed Dose Symptoms

Missing a dose of methadone leads to unpleasant opioid withdrawal symptoms. The most common symptoms include muscle aches, fatigue, restlessness and nausea. These symptoms can be severe and are relieved by taking methadone. 

How long can you stay on methadone?

For methadone, 12 months is usually considered the minimum amount of time and many patients are successful on methadone maintenance for years. There is no issue with staying on methadone in the long term and stopping of the medication should not be rushed.

Getting Off of Methadone

Stopping methadone requires a tapper.  Usually, methadone dosages can be reduced by 2.5-5 mg per week without serious withdrawal symptoms. 

To get off methadone successfully, patients should have stability in their recovery like employment and counseling. Transitioning to Suboxone can stop the daily dosing, but keep the anti-craving stabilization. 

See also: Methadone vs. Suboxone

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