Methadone and Oral Sedation

Methadone is a powerful opioid used for maintenance treatment as part of the process of treating opioid dependency. It is also increasingly used for treatment of chronic pain, as it is longer-lasting than many painkillers and may treat neuropathic pain more effectively.

A DOCS Education Member inquires:

Hi all,
I am new to the forum and to DOCS, so I apologize if this has been asked and answered before. I have a patient who is on methadone. Are there any special protocols or cautions to be considered when treating this patient? I understand that methadone is a cytochrome p450 inhibitor and CNS depressant. The patient takes one dose per day in the morning. Thanks!


Dr. Jerome Wellbrock, DOCS Education faculty member, responds:

Hello,
It was great to meet you this past weekend in SF. I hope you enjoyed the weekend as much as we did teaching the courses. We can treat patients with a history of—or current methadone use, but if they have a significant tolerance to the drugs it may be difficult to reach an adequate level of sedation with oral sedation meds. Usually these patients are better managed with IV Sedation where it is easier to titrate to effect. If you decide to sedate this patient you may want to talk to them about this concern and if they are willing to try then I would give it a go. Thanks for posting and I look forward to seeing you at a future DOCS program.

issue_no: 
1
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.