methadone

If you use this medication regularly and miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Read the Patient Information Leaflet that may be provided by your pharmacist before you start using methadone and each time you get a refill. If you have any questions, consult your doctor or pharmacist. This medication is given by injection into a vein, into a muscle, or under the skin. Use it exactly as directed by your doctor. Read and learn all of the manufacturer's instructions for preparation and use. If you have any questions about using this medication properly, consult your doctor or pharmacist. The dosage is based on your medical condition and response to treatment. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Before injecting each dose, clean the injection site with rubbing alcohol. If this medication is given into a muscle or under the skin, it is important to change the location of the injection site with each dose to avoid problem areas under the skin. Learn how to store and discard needles and medical supplies safely. Consult your pharmacist for more details. If nausea occurs, consult your doctor or pharmacist for ways to decrease it (such as taking antihistamines, lying down for 1 to 2 hours with as little head movement as possible). If you are using this medication for pain, remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well. This medication may cause withdrawal reactions, especially if it has been used regularly for a long time or in high doses. In such cases, withdrawal symptoms (such as restlessness, watery eyes, widened pupils, sweating, runny nose) may occur if you suddenly stop using this medication. To prevent withdrawal reactions, your doctor may reduce your dose gradually. Consult your doctor or pharmacist for more details, and report any withdrawal reactions immediately. When this medication is used for a long time, it may not work as well. Your doctor may need to increase your dose or change your medication. Talk with your doctor if this medication stops working well. Rarely, abnormal drug-seeking behavior (addiction) is possible with this medication. Do not increase your dose, use it more frequently, or use it for a longer time than prescribed. Properly stop the medication when so directed. Tell your doctor if your condition persists or worsens.

Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first. This drug should not be used with the following medication because very serious interactions may occur: naltrexone. If you are currently using this medication, tell your doctor or pharmacist before starting methadone. Many drugs besides methadone may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, among others. This is not a complete list. Therefore, before using methadone, report all medication you are taking to your doctor or pharmacist. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: certain medications for pain (opiate partial agonists such as butorphanol, nalbuphine, pentazocine), drugs affecting liver enzymes that remove methadone from your body (such as St. John's wort, certain HIV NNRTIs including efavirenz/nevirapine, HIV protease inhibitors including ritonavir, rifamycins including rifampin, azole antifungals including itraconazole, macrolide antibiotics including erythromycin, certain anti-seizure medicines including phenytoin/carbamazepine/phenobarbital, certain SSRI antidepressants including fluvoxamine/fluoxetine/sertraline), MAO inhibitors (such as furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine), certain HIV NRTIs (stavudine, zidovudine, didanosine chewable/dispersible buffered tablets or pediatric oral solution). The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if you use this medication with other products that may also affect breathing or cause drowsiness. Therefore, tell your doctor or pharmacist if you are taking other products such as alcohol, medicine for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and psychiatric medicines (such as risperidone, amitriptyline, trazodone). Your medications or doses of your medications may need to be changed. Check the labels on all your medicines (such as cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely. This medication may interfere with certain laboratory tests (including amylase and lipase levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Do not share this medication with others. It is against the law. This medication has been prescribed for your current condition only. Do not use it later for another condition unless told to do so by your doctor. A different medication may be necessary in those cases.

If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow/shallow breathing, extreme drowsiness, slow heartbeat, severe dizziness, pinpoint pupils.

Before using methadone, tell your doctor or pharmacist if you are allergic to it; or to other narcotic pain medications (such as propoxyphene); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: certain bowel diseases (paralytic ileus, infectious diarrhea). Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, lung diseases (such as asthma, chronic obstructive pulmonary disease-COPD), breathing problems (such as slow/shallow breathing, sleep apnea), a certain spinal problem (kyphoscoliosis), personal or family history of regular use/abuse of drugs/alcohol, brain disorders (such as seizures, head injury, tumor, increased intracranial pressure), underactive thyroid (hypothyroidism), difficulty urinating (for example, due to enlarged prostate or narrowed urethra), adrenal gland problem (such as Addison's disease), mental/mood disorders (such as toxic psychosis), intestinal diseases (such as colitis), disease of the pancreas (such as pancreatitis), gallbladder disease. Methadone may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can infrequently result in serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that require immediate medical attention. The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may affect the heart rhythm (see also Drug Interactions section). Before using methadone, tell your doctor or pharmacist if you have any of the following conditions: family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death), certain heart problems (slow/fast/irregular heartbeat, QT prolongation in the EKG, heart failure). Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using methadone safely. This drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid alcoholic beverages. To lower your risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. Before having surgery, tell your doctor or dentist that you are using this medication. Older adults may be more sensitive to the effects of this drug, especially slow/shallow breathing and drowsiness. During pregnancy, this medication should be used only when clearly needed. Using it for long periods or in high doses near the expected delivery date is not recommended because of possible harm to the unborn baby. Discuss the risks and benefits with your doctor. Pregnancy may also affect the amount of this drug in your body, so tell your doctor immediately if you become pregnant. You may require different dosing. Infants born to mothers who have used this medication for a long time may have withdrawal symptoms such as irritability, abnormal/persistent crying, vomiting, or diarrhea. Tell your doctor immediately if you notice any of these symptoms in your newborn. This medication passes into breast milk and is unlikely to harm a nursing infant. Consult your doctor before breastfeeding. If breastfeeding is suddenly stopped, the nursing infant may experience withdrawal symptoms. Discuss with you doctor a plan for breastfeeding your baby.

Store in the original carton at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

See also Warning section. Nausea, vomiting, constipation, lightheadedness, dizziness, dry mouth, drowsiness, and increased sweating may occur. Pain, redness, or swelling at the injection site may occur if this medication is given into a muscle or under the skin. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. To prevent constipation, maintain a diet adequate in fiber, drink plenty of water, and exercise. Consult your pharmacist for help in selecting a laxative (such as a stimulant type with stool softener). Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these unlikely but serious side effects occur: mental/mood changes (such as agitation, confusion, hallucinations), difficulty urinating, vision changes. Tell your doctor immediately if any of these rare but very serious side effects occur: severe stomach/abdominal pain, change in the amount of urine, seizures. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Methadone has caused very serious (possibly fatal) breathing and heart rhythm problems (QT prolongation in the EKG, torsades de pointes). These problems are more likely to occur when this medication is first started or when the dose is increased. Breathing problems may occur a while after you receive the dose (for example, more than 8 hours later). Carefully follow your doctor's directions on how to use the medication. Even if this medication is not working well, do not increase your dose or use this medication more often than prescribed without first consulting your doctor. It may sometimes take 3 to 5 days before you get the full benefit of pain relief from this medication. Seek immediate medical attention if you develop symptoms of breathing and heart rhythm problems, such as slow/shallow breathing, fast/irregular heartbeat, severe dizziness, or fainting.