methadone
hydrochloride
Dolophine, Methadose
Nursing Considerations
• Before giving methadone, make sure opioid
antagonist and equipment for administering
oxygen and controlling respiration
are nearby.
• Before therapy begins, assess patient’s current
drug use, including all prescription
and OTC drugs.
WARNING Give drug cautiously to patients
at risk for a prolonged QT interval, such as
those with cardiac hypertrophy, hypokalemia,
or hypomagnesemia; those with a
history of cardiac conduction abnormalities;
and those taking diuretics or medications
that affect cardiac conduction.
• Dilute oral concentrate with water or
another liquid to volume of at least 30 ml,
but preferably to 90 ml or more, before
administration. Dissolve dispersible tablets
in water or another liquid before giving.
•Monitor patient for expected excessive
drowsiness, unsteadiness, or confusion
during first 3 to 5 days of therapy, and
notify prescriber if effects continue to
worsen or persist beyond this time.
WARNING Monitor respiratory and circulatory
status carefully and often during
methadone therapy because respiratory
depression, circulatory depression, respiratory
arrest, shock, hypotension, and cardiac
arrest are risks. Monitor children
often for respiratory depression and paradoxical
CNS excitation because of their
increased sensitivity to drug. Assess
patient for excessive or persistent sedation;
dosage may need to be adjusted.
•Watch for drug tolerance, especially in
patients with a history of chronic drug
abuse, because methadone can cause physical
and psychological dependence.
•Monitor patient for pain because maintenance
dosage doesn’t provide pain relief;
patients with tolerance to opiate agonists,
including those with chronic cancer pain,
may require a higher dosage.
•Monitor patients who are pregnant or
who have liver or renal impairment for
increased adverse effects from methadone
because drug may have a prolonged duration
and cumulative effect in these
patients. Methadone may prolong labor by
reducing strength, duration, and frequency
of uterine contractions, so expect dosage
to be tapered before third trimester of
pregnancy. Breast-feeding mothers on
maintenance therapy put their infants at
risk of withdrawal symptoms if they
abruptly stop breast-feeding or discontinue
methadone therapy.Methadone also
accumulates in CNS tissue, increasing the
risk of seizures in infants.
• Check plasma amylase and lipase levels in
patients who develop biliary tract spasms
because levels may increase up to 15 times
normal. Notify prescriber immediately of
any significant or sustained increase.
•Monitor patients who have head injuries
or other conditions that may increase
intracranial pressure (ICP) because
methadone may further increase ICP.
• Assess patient for withdrawal symptoms
and tolerance to therapy because physiologic
dependence can occur with longterm
methadone use. Avoid abrupt discontinuation
because withdrawal symptoms
will occur within 3 to 4 days after last
dose.
•Monitor patients, especially the elderly, for
cardiac arrhythmias, hypotension,
hypovolemia, orthostatic hypotension, and
vasovagal syncope because methadone
may produce cholinergic effects in patients
with cardiac disease, resulting in bradycardia
and peripheral vasodilation; dosage
decrease may be indicated.
•Monitor patients with prostatic hypertrophy,
urethral stricture, or renal disease for
urine retention and oliguria because
methadone can increase tension of detrusor
muscle.
• Be prepared to treat patient’s symptoms of
anxiety, and be aware that anxiety may be
confused with symptoms of opioid absti-
nence and that methadone doesn’t have
antianxiety effects.
PATIENT TEACHING
• Instruct patient taking oral concentrate
form of methadone to dilute it with water
or another liquid to a volume of at least 30
ml and preferably to 90 ml or more before
administration.
• Instruct patient to dissolve dispersible
tablets in water or other liquid before
administration.
• Advise patient to notify prescriber of all
other drugs he’s currently taking and to
avoid alcohol and other depressants, such
as sleeping pills and tranquilizers, because
they may increase drug’s CNS depressant
effects.
• Instruct patient to take drug only as prescribed
and not to change dosage without
prescriber approval. Inform patient that
abrupt cessation of methadone therapy
can precipitate withdrawal symptoms.
Urge him to notify prescriber if he develops
any concerns over therapy.
• Urge patient to notify prescriber if he
experiences palpitations, dizziness, lightheadedness,
or syncope, which may be
caused by methadone-induced arrhythmias.
• Instruct patient to avoid potentially hazardous
activities or those that require
mental alertness because methadone therapy
may cause drowsiness or sleepiness.
• Teach patient to change positions slowly to
minimize the effects of orthostatic hypotension.
• Instruct patient to notify prescriber of
worsening or breakthrough pain because
dosage may need to be adjusted.
• Inform parents that a child on methadone
maintenance therapy may become unusually
excited or restless; advise them to
notify prescriber of changes in child’s
behavior.
• Instruct female patient to notify prescriber
immediately if she becomes pregnant during
methadone therapy because drug may
cause physical dependence in fetus and
withdrawal symptoms in neonate.
• Caution patient who is breast-feeding not
to stop doing so abruptly and not to stop
taking methadone without prescriber’s
approval because infant may experience
withdrawal symptoms.
