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
- Patients with low or unknown tolerance to opioids, the dose should be lowered to 10-15 mg.
- Patients with higher tolerance, the dose should be increased but not exceed 30 mg
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.
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.ⓘ)
Methadone DOsing Phases
| Phase | Purpose | Range in MG |
| Initial Dose | Relieve withdrawal symptoms | 20-40 mg |
| Early Induction | Reach established tolerance level | + / – 5-10 mg |
| Late Induction | Establish adequate dose (desired effects) | + / – 5-10 mg |
| Maintenance | Maintain desired effects (stedy-state occupation of opiate receptors) | Ideally 60-120 mg |
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
What is the maximum daily 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.
What is the lethal dose of methadone?
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.
Can you 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
What is the methadone dosing for detox only?
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.
- If one or two doses are missed, the patient can likely stay at the same methadone dosage.
- If three doses are missed, the next dose should be 25% lower. If the reaction to the dose is good, the patient can return to the previous dosing levels the next day.
- If four doses are missed, the next dose should be reduced by 50% and should be increased over several days back to previous levels.
- If five or more doses are missed, the patient will need to do a new induction.
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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1 2 3 … 6 MORE ›I am on 190 mg. Many people take much higher doses due to the strong opiates now available.
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.
While 120 mg is the official medical recommendation, it’s more critical that doses aren’t too low to effectively prevent drug cravings or use. The higher the dose of methadone, the higher the risk of complications, but everyone is different with regard to the needed or ideal methadone maintenance dose.
According to 2022 PEW data, only these 3 states restrict higher methadone dosing: Arkansas, Tennessee and Mississippi. Sadly, these state laws would apply to both private and public clinics.
I agree. Street Fentanyl is strong, it’s staying in a user’s system far longer than what we’ve seen in the past and the average dose in NE OHIO is around 150mg.
Hi Isabel. I am on 295mg. A few years ago I was on 315mg.
Everyone’s case is unique, however the number should not mean anything insofar as the clinician’s judgement about a patient’s stability and dose appropriateness.
It’s always preferable to use the least amount of medicine needed to achieve the desired effect while taking the side effect profile into account. The two primary contraindications for high-dose methadone (in New England it is anything >200mg ) are QT prolongation (a cardiac rhythm abnormality that may have been previously undetected) and metabolic considerations (renal/hepatic insufficiency, taking medications that inhibit methadone metabolism, age, general health, etc).
Regular ECGs are ordered (yearly at least) to make certain there are no abnormalities .
I’m someone who had a very, very high tolerance and dependency due to a near limitless supply of the opioids I abused. It’s a miracle I’m alive and I’m recovery.
I used to view methadone as something that was strictly harm reduction in that “we know you’re going to continue to get high regardless so let’s substitute something in that we can stabilize you on and you won’t kill yourself”.
While it is true this is all methadone is to some (and that’s ok), for me it has allowed a return to near normalcy. I have a family (none of whom have an addiction disorder), a great second career that I love (because my addiction destroyed my first one in medicine) and happiness in my life.
I also suffer from chronic pain and am a medical marijuana patient (something my clinic is fine with and does not prevent me from getting take home doses).
In summary, methadone dosage is as individualized as handmade suit. It depends on many factors, but most of all, YOU need to be comfortable with your treatment team. If ALL you are getting is a sip of liquid daily and/or you feel pressured to go up on your dose, I would recommend seeking help elsewhere. Fast.
Hello,
I am stable on monthly take home dosing and have been clean for a significant period. My dose is 58 milligrams daily. I dropped one of my bottles and the entirely of the dose was lost. I will have to either skip a dose completely, or cut one in half to make it to my next appointment. Neither option is desirable; I tend to experience withdrawal pretty quickly. What do you suggest? Skipping a dose and going 48 hours between dosing, or splitting the dose in two and taking half each day?
Thank you. Gretchen G.
I just started taking methadone 6 days ago. I started at 30 mg and past 2 days I’ve taken 35mg. I have no way to get to clinic tomorrow so was wondering how bad my withdrawal will be when I miss this next dose.
I am on 135 mgs since 2014. Has anyone ever had a Sweating or always feeling Hot problem? I sweat constantly and I’m so Hot! I’m wondering if I’m actually in withdrawal and need to up my dose or is this “normal” being on Methadone?! Also I never have any energy. Trying to do something simple like washing dishes is so hard to accomplish and totally drains me. It’s as if I’m out in the hot sun for hours digging a hole, sweating like crazy!
Sweating is a known side effect of methadone but can be managed. Lowering the dose may help you, if possible. There are also medications like Oxybutin and desloratadine that help with sweating, as well as prescription deodorants and drinking plenty of water. Sweating can also trigger eczema flare-ups. That said, I’d need to do an actual exam to know if something else going on. While sweating is a side effect, patients should feel good while taking methadone. Your methadone clinic should be looking at your symptoms and helping you get relief.
I also feel crazy hot out of nowhere and lose energy in phases throughout the day
I had that problem Sweating in early am hours. I was on 190 mg for 10 year. I believe it was due to a too high dose. I recently got back on methadone and I’m good at 80 MG, no sweats at all..
Stay out of the sun. Slow down but if you that tired just washing dishes you don’t need any more methadone. . If your doing the nod you know your doing too much.
Why are pharmacists profiling legitimate palliative care patients on opioids particularly methadone?
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.
When you say a 120mg dose is that with juice and methadone mixed or a straight methadone with zero juice??
Milligrams is the potency of the medication not the quantity of liquid.
It would still be 120mg with however many oz of juice you get.
Saying 120 mgs or 50 mgs means the amount of medicine that is with the juice. I take mine with a lot of water but the medicine inside the bottle stays stays the same. I prefer more water for stomach reasons.
What is minimum hours between dosages?
Most methadone doses are given as a once-daily dose, and it is recommended to take it around the same time each day. In certain situations where split dosing (twice daily dosing) is required, it is recommended to have the doses 12 hours apart.