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
87 Comments
Hello 🙂 I’d like to butt in for a moment and say that I am on 120 milligrams of methadone for the last three years. My only dirty drug screen in those three years has only been the first one I’ve even taken for inake, I’ve been clean since. But with that being said, I have been clean the entire time, but I do always seem to be hotter than my husband later on throughout the day .But sweating, not so much, just really in the beginning.It was like that. I was just wondering.Have you been dabbling here and there possibly also? I hope I’m not being too invasive (no ill intentions)with that question.I was just Wondering because that also could have something to do with the levels of your internal thermometer being off ? I would like to start tapering because the main thing that I have experienced was weight.Gain weight gain and the fact that my breathing issues have gotten slightly worse even though I do smoke cigarettes and weed , but it also has something to do with this weight gain and I’m guessing ????♀️I really don’t even eat much and I started at 130 ( I never really lost weight with my drug use)and her I am now at 165?! Bro…. lol I’d like to start my taper the next time I go to receive my bottles. I was wondering as well.How many bottles are you allowed in your state? Here in Connecticut.I am allowed twenty seven bottles , but it’s also because I’ve been clean for awhile, to even be trusted to recieve that many at a atime. And one more thing(, sorry I have AD.H.D) Getting back to this Sweating situation, if I have a really bad stomachache or if I wind up getting cold and really hot really quick. I will be kinda traumatized to remembering. That’s how I felt in withdrawal and it automatically make me feel ill. But it will go away within the next 15 minutes. It’s just the way the mind works. I believe..
So I have a liquid bottle of methadone that reads 40 1.5 tablet 60 ml how do I get a beginners dose out of that for some one kicking
Hi there, I’ve been tapering off of methadone after being on it for 10 years. Once I’m completely off of it how long will it take to be completely out of my system for me to be “normal” ?
What is the procedure for increasing methadone over x amount? Do they need to perform an EKG or check the heart before increase?
How do you induce a patient on methadone after the initial 20 to 30mg starting dose