A Simple Guide to Methadone Dosing

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.

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.

Looking to Start Methadone?

How Long Does It Take For Methadone To Kick In?

Within 30 minutes patients should feel the effects of methadone. The medication peaks around hour four. Typically, it takes 3 to 5 days to reach maximum effectiveness and stabilized levels of methadone in the body.

How Long Does A Dose Of Methadone Last?

Most patients maintain relief from the medication for around 25 hours, which is the half-life of methadone. (Half-life is when 50% of the medication is still in the body and 50% has been removed).  This is why dosing is usually done daily.

See also: How Long Does Methadone Stay In the Body?

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. 

However, what’s most important with the dose is that the medication is effective in preventing cravings and withdrawal symptoms. In all but three states, providers are able to exceed the 120 mg recommendation.

(Very rarely, patients are stabilized for low-dose maintenance, which is 20 to 60 mg.)

The four phases of methadone dosing chart

Side effects of methadone tend to be worse in the induction phases and improve with time. Side effects that linger into the maintenance phase can usually be treated. 

See also: Side effects of Methadone

How Do You Determine The Methadone Dosage?

Tolerance determines the appropriate methadone dose. Tolerance is shaped by the time using opioids, the amount used, the type of opioid and how a person’s body metabolizes opioids. 

Tolerance is measured by monitoring the reaction to each dose. If there is intoxication or sedation, the dose likely should be lowered. If there are significant withdrawal symptoms, the dose likely should be increased.

Patients typically need to be on the same dose for at least three days without a missed dose before a dose increase.

How Long Does It Take To Stabilize On Methadone?

The majority of patients get to the maintenance phase of methadone treatment within 2-8 weeks. If doses are missed, the process takes longer.

How Long Can You Be on Methadone?

The minimum amount of time recommended for methadone maintenance is 12 months. Many patients are successful on methadone for years and stopping the medication should never be rushed.

More Methadone Dosing FAQs

A high dose of methadone during stabilization is considered anything over 100 mg. However, 40 mg would be considered a high initial dose of methadone.

The recommended maximum daily dose of methadone is 120 mg. Most providers prefer to stay within this limit. 

However, as illicit opioids become more potent, some patients may need to go over this recommendation. It is very rare that a patient needs a maintenance dose over 200 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.  Even with opioid tolerance, it is possible to overdose on methadone.

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

See also: Methadone Overdose article

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.

What Are The Symptoms Of A Missed Methadone Dose?

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 Do You Stop Taking 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 any daily in-person dosing, but keep the anti-craving stabilization. 

See also: Methadone vs. Suboxone

Still Have Questions?

Subscribe
Notify of
guest

14 Comments
Most Voted
Newest Oldest
Inline Feedbacks
View all comments
Isabel
Isabel

I am on 190 mg. Many people take much higher doses due to the strong opiates now available.

Julie
Julie
Reply to  Isabel

Hi Isabel, maybe where u r from but in some places 120mg is as far as they let u go. My husband has been trying get his dose higher for over a year now and they keep telling him the State won’t allow it. I thought my clinic was privately owned and funded but I do know that some states will let u get higher.

Sheila
Sheila

Indiana methadone clinic’s go higher than 120mg as well. I’m not sure where

Ralph
Ralph
Reply to  Julie

That’s bull crap all though I don’t know what state you guys live in NY I’ve gone from 100 mgs down to 40 I just went back to 50 mgs cause I came down to fast the program I is a big hospital I never heard of what you guys are going through

Ralph
Ralph
Reply to  Ralph

Oh yeah Julie the thing is if your husband has just started most programs rather that you stay on for a good year or more with no dirty urines the good thing is that my urine are always clean so I don’t have any problem and I the maximum take home bottles one I drink there and I get twenty seven take homes that’s with all clean urines do the right thing and he’ll be fine stay clean and stay safe all the best to you guys and have a happy thanksgiving

Maribeth
Maribeth

Why are pharmacists profiling legitimate palliative care patients on opioids particularly methadone?

Michelle S.
Michelle S.
Reply to  Maribeth

I’m not sure what you mean by profiling, but there was a serious lack of accountability in the medical community that fueled the opioid epidemic. Many substance use patients still start opioids with legitimate medical concerns. We need checks and resources for patients, doctors and pharmacists without restricting access to appropriate doses of medications.

Troy
Troy

When you say a 120mg dose is that with juice and methadone mixed or a straight methadone with zero juice??

Beans
Beans
Reply to  Troy

Milligrams is the potency of the medication not the quantity of liquid. Bruhhhhh

Julie
Julie
Reply to  Troy

It would still be 120mg with however many oz of juice u get.

Ralph
Ralph
Reply to  Troy

What they are saying 120 mgs or 50 mgs they are telling you the amount of medicine is with the juice I take mine with a lot of water but the medicine inside the bottle stays 120,50, or what stays the same I prefer more water for stomach reasons we are on methodose which is is the same thing and I’m on it for decades and worked two jobs for many years I got a big family

Ron
Ron

What is minimum hours between dosages

Symetria doctors follow rigorous sourcing guidelines and cite only trustworthy sources of information, including peer-reviewed journals, court records, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the field.

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

Disclaimer
All content is for informational purposes only. No material on this site, whether from our doctors or the community, is a substitute for seeking personalized professional medical advice, diagnosis or treatment. Never disregard advice from a qualified healthcare professional or delay seeking advice because of something you read on this website.

Symetria has addiction treatment clinics across Illinois and Texas. You can likely get scheduled TODAY — medications or therapy. 

Hi there — Most people want to know costs/insurance upfront. Would you like to check your policy now?