Authors' recommendations: No information was identified from studies or guidelines to support a defined maximum daily dose for methadone when used for the management of pain in patients with a history of opioid addiction. Results from observational studies indicate that the optimal analgesic dose of methadone varies widely among participants when titrated according to analgesic effect and can be significantly higher than the maximum dose recommended for methadone maintenance treatment of opioid addiction.Current guidelines indicate that individuals receiving doses of methadone greater than 120 mg per day should be monitored for cardiac arrhythmias and other adverse effects. Further studies are needed to establish dosing recommendations and long-term feasibility of methadone treatment.In conclusion, dosing and administration of methadone for the management of pain in patients with a history of opioid addiction, including those enrolled in MMTPs, should be individualized and take into account the nature and severity of pain, degree of tolerance to the analgesic effects of methadone, and risk factors for adverse effects including cardiac arrhythmias and respiratory depression.

Project Status: Completed

URL for project: http://www.cadth.ca/media/pdf/L0110_Methadone_Maximum_Dose_final.pdf

Year Published: 2009

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)