Methadone Hydrochloride for Opioid Recovery

Methadone hydrochloride is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat detoxification and provide maintenance treatment of opioid use disorder in adults.

How Methadone Hydrochloride Works and How It’s Taken

Methadone hydrochloride is a type of opioid called a mu-opioid agonist. It acts on opioid receptors in the body. During methadone maintenance treatment, the dose is adjusted to help prevent opioid withdrawal symptoms for 24 hours, reduce opioid cravings, and reduce the pleasurable effects of other opioids.

Doctors prescribe Methadone Hydrochloride when a person needs detoxification or maintenance treatment for opioid use disorder. Maintenance treatment should be given along with appropriate medical and social support.

Methadone used for opioid use disorder must be given under federal treatment rules. It is generally dispensed through certified opioid treatment programs, with certain regulatory exceptions.

Methadone comes in five dosage forms:

Oral concentrate — Taken by mouth and must not be injected. Some oral concentrate products should be diluted with water or another liquid before taking.
Oral solution — Taken by mouth. A graduated measuring device should be used to measure the dose accurately, not household teaspoons or tablespoons.
Tablets — Taken by mouth as directed.
Tablets for oral suspension — Mixed with water, orange juice, or another acidic fruit drink right before taking. The tablets should not be chewed or swallowed before they are mixed.
Injection — Given into a vein, muscle, or under the skin. For opioid use disorder, the injection is used only temporarily for people who cannot take methadone by mouth, such as some hospitalized people, and is not approved for outpatient treatment of opioid use disorder.

Typical Dosing for Opioid Use Disorder

Oral concentrate, oral solution, and tablets

Treatment usually starts with 20 to 30 milligrams. The first dose should not be more than 30 milligrams.

If needed, another 5 to 10 milligrams may be given after two to four hours. The total dose on the first day should not usually be more than 40 milligrams.
For short-term detoxification, the dose is adjusted until the person is stable and then gradually reduced.
For maintenance treatment, the dose is adjusted for each person. Clinical stability is most commonly achieved with 80 to 120 milligrams per day.
When maintenance treatment is being stopped, the dose is generally reduced by less than 10 percent at a time, with about 10 to 14 days between reductions.

Tablets for oral suspension

The same general dosing approach is used, but this dosage form can only provide doses in 10-milligram increments.

Injection

For someone switching from oral methadone to methadone injection, the recommended initial conversion is a 2-to-1 oral-to-injection ratio. For example, 10 milligrams taken by mouth is converted to about 5 milligrams by injection, and the dose is then adjusted for the individual.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Methadone Hydrochloride Side Effects

Common side effects include:

Lightheadedness
Dizziness
Sedation (sleepiness)
Nausea
Vomiting
Sweating

Serious Side Effects and Warnings

Methadone hydrochloride can cause serious side effects that may require immediate medical attention. These include:

Respiratory depression (dangerously slow or shallow breathing) — This can lead to breathing failure.
QT prolongation and serious heart rhythm problems — Changes in the heart’s electrical activity can cause a dangerous abnormal rhythm, including torsades de pointes.
Hypotension (severe low blood pressure) — Blood pressure can drop suddenly and may cause fainting.
Serotonin syndrome — This potentially life-threatening reaction can cause agitation, hallucinations, fever, fast heart rate, muscle stiffness, or diarrhea, especially when methadone is taken with certain antidepressants or other serotonergic drugs.
Adrenal insufficiency (low adrenal hormone levels) — This can cause nausea, vomiting, loss of appetite, unusual tiredness, weakness, dizziness, or low blood pressure.
Anaphylaxis (severe allergic reaction) — This can include hives, swelling, or trouble breathing.
Hypoglycemia (low blood sugar) — Blood sugar can drop too low, which may cause sweating, shakiness, confusion, or fainting.
Sleep-related breathing problems — These can include central sleep apnea, in which breathing repeatedly stops and starts during sleep.
Esophagus problems — Opioids can sometimes cause trouble swallowing, regurgitation, or chest pain not caused by the heart. This may be more likely with higher doses or longer opioid use.
Head injury or increased pressure in the skull — Methadone can reduce breathing, which may further increase pressure in the skull. It may also make it harder to evaluate a head injury.

Methadone hydrochloride has a boxed warning, the FDA’s strongest safety warning, for some of the serious risks mentioned above. A boxed warning does not mean the drug is unsafe for everyone or that everyone faces the same level of risk.

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Methadone Hydrochloride

Tell your doctor if you are allergic to methadone or any ingredients in your methadone product.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Do not take methadone hydrochloride if you have:

Serious breathing problems
Acute or severe bronchial asthma without medical monitoring or emergency breathing equipment
A known or suspected blockage in your stomach or intestines, including paralytic ileus
An allergy to methadone or ingredients in the product

Be careful with other medicines and alcohol. Benzodiazepines, alcohol, and other medicines that slow the brain and nervous system can cause severe sleepiness, serious breathing problems, coma, or death when used with methadone. Some medicines can also raise or lower methadone levels in the body, so your healthcare provider should know everything you take.

Methadone can make you sleepy and affect your ability to think or react. Do not drive, operate heavy machinery, or do other dangerous activities until you know how methadone affects you.

People and caregivers should also talk with a healthcare provider about having access to an opioid overdose reversal medicine, such as naloxone or nalmefene, in case of an overdose.

If you are pregnant or think you may be pregnant, tell your healthcare provider. Methadone use during pregnancy can cause neonatal opioid withdrawal syndrome, which means the baby may have withdrawal symptoms after birth. This condition can be serious but is treatable.

If you are breastfeeding, watch your baby for unusual sleepiness, trouble breastfeeding, breathing problems, or limpness. Contact your baby’s healthcare provider right away if these occur.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is methadone hydrochloride for opioid use disorder?

Clinical data for methadone do not give a single success rate. For oral methadone, maintenance treatment is adjusted to help prevent withdrawal symptoms for 24 hours, reduce opioid cravings, and reduce the effects of other opioids. Clinical stability is most commonly achieved with 80 to 120 milligrams per day, although the dose is tailored to each person.

How long does methadone hydrochloride take to work for opioid use disorder?

Clinical data does not give an exact time for when methadone starts working. For oral methadone, an initial dose of 20 to 30 milligrams is often enough to reduce withdrawal symptoms. If symptoms continue or return, the person may be checked again after two to four hours, when methadone is expected to reach peak levels or peak activity.

Does methadone hydrochloride interact with other medicines?

Yes. Methadone can interact with several types of medicines. Benzodiazepines and other medicines that slow the central nervous system can increase the risk of severe sleepiness and dangerous breathing problems.

Some medicines can also raise methadone levels and increase side effects, while others can lower methadone levels and cause withdrawal symptoms. Examples include certain antibiotics, seizure medicines, antifungal medicines, HIV medicines, and St. John’s wort. Tell your healthcare provider about all prescription medicines, over-the-counter medicines, and supplements you take.