A Simple Guide to Methadone Dosing

Clinical Reviewer

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.)

Methadone DOsing Phases

PhasePurposeRange in MG
Initial DoseRelieve withdrawal symptoms20-40 mg
Early InductionReach established tolerance level+ / – 5-10 mg
Late Induction Establish adequate dose (desired effects)+ / – 5-10 mg
MaintenanceMaintain 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

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

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.

Still Have Questions?

Leave a Reply

Your email address will not be published. Required fields are marked *

*

 

85 Comments

    1. 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.

    2. 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.

    3. Julie, attorney here, and clinics that are privately owned and funded still have to abide by the laws of the state(s) in which they operate. Based on how you worded your comment, it wasn’t clear to me if you knew that or not so I just wanted to clarify for you just in case.

  • 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!

    1. 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.

    2. I was on methadone for five yrs before relapsing and recently started back on methadone. but during those five years I was on 110 mg and would sweat all the time. the paperwork they gave me said excessive sweating was a side effect.

    1. 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.

    1. 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.

  • 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.

    1. Try contacting your clinic first, they may be able to provide you with an exception dose so that you don’t miss a dose. If you are not experiencing any withdrawal at the current dose, then missing one dose may not cause you any withdrawal at all. If you are still experiencing some withdrawal at 35mg daily, then your withdrawal will definitely worsen if you miss a dosing day, but it will not be severe withdrawal.

    2. I would also suggest calling in. Typically clinics have social workers who can help with finding rides or connect you with a local NA group members of NA will often give people rides to the clinics. Hope you find some consistency even if it’s not NA support groups are an important part of recovery. Bless you for starting that journey!

    3. If you have medicaid you can call motocare /logosticsre and set up reservations for 73 hours(3business days m-f) ahead of time. If you’re going everyday then your clinic can provide what’s called a standing order and usually you will fill out the time you’d like to go to clinic&leave clinic to go back home. Your counselor should do the rest&fax it over. Thus providing you with transportation to any and all Dr’s appointments as well…just remember the 3 day rule and watch out for holidays! If you don’t show up for the rides however it will Marr your reputation of reliability &could cause future issues with being picked up to go to apps. Call 24 hrs ahead to cancel if possible of not possible then asap. Good luck

  • 1 2 3 12
    What To Read Next
    Do you live in Illinois or Texas?

    Symetria has addiction treatment clinics across the state. 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?