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
86 Comments
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.
Hi, I have been on MMT for a few years now and during the past year I’ve my dose is not working as well. By evening I start feeling bad. My blood pressure raises, constant yawning and my skin starts crawling, restless legs and craving. By morning I can’t get to the clinic fast enough! I’ve asked my counselor a dozen times to put in for an increase for me and he never does, except for my yearly physical 2 months ago and I got a 5 mg increase then, but I’m still feeling awful I’m not sleeping right I feel terrible. I had surgery a couple months ago and for the first time ever I could actually feel the pain medication from the surgery and I’m craving terribly. My question is, is this normal for an MMT patient to need an increase after being in treatment for a period of time?
It’s uncommon for a person to need methadone dosage adjustment once reaching a stable dose. However, a change in another medication you were taking can explain it. For example, if you were on an SSRI antidepressant for a while and then stopped the SSRI, that can cause you to feel opioid withdrawal. If you are taking an anticonvulsant medication (carbamazepine, phenytoin, or phenobarbital) that can also cause a reduction in serum methadone levels which can lead to feeling withdrawal. Pregnancy also requires a dose increase in methadone. I’d recommend speaking to your medical provider again to further investigate why you have been feeling withdrawal over the past year, and to have them increase your methadone dose.
someone missed there dose 185 mg and won’t have it for today and tomorrow. Can they get through till monday
I was on 60mg for 6 years. I’ve been getting off, down to 30mg now. I would like to know the lowest dose to quit Methadone.
How much methadone is to much