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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.

Medications Can Impact Methadone Dosing

Certain medications like those for HIV treatment and some antidepressants have been shown to impact the levels of methadone in the body. The dose of methadone may need to be adjusted up or down to accommodate the interaction of the other medication.  

See also: Drugs That Interact With Methadone

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 is considered anything over 100 mg, but dosages may need to be much higher than that.  One study looking at the dosages of high-dose patients showed a median dose of 211 mg.

Also, keep in mind that 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.  As a very simple rule, methadone dosages can usually be reduced by 2.5-5 mg per week without serious withdrawal symptoms. 

See also: How To Get Off Methadone

To get off methadone successfully, patients should have stability in their recoveries 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

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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.

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