From the Guidelines
Vomited methadone doses should not be replaced without careful assessment by a healthcare provider, considering the timing of vomiting and potential absorption of the medication, as stated in the guidelines for prescribing opioids for pain 1. When considering replacement of a vomited methadone dose, the timing of vomiting after dose administration is crucial.
- If a patient vomits within a short time frame after taking methadone, the dose may be partially or fully replaced, depending on the specific clinic protocol and the healthcare provider's assessment.
- However, if vomiting occurs more than 30 minutes after ingestion, replacement is generally not recommended as significant absorption has already occurred 1. The decision to replace a dose should be made by a healthcare provider who can assess the situation, including whether the vomited material visibly contains the medication.
- Replacement doses are often given at half the original dose to avoid potential overdose, as some medication may have been absorbed despite vomiting 1. This cautious approach is necessary because methadone has a long half-life and accumulates in the body, making overdose a serious risk 1. Patients on methadone maintenance who experience repeated vomiting should be evaluated for underlying medical conditions or potential medication interactions that might be causing the vomiting, as recommended by the CDC clinical practice guideline for prescribing opioids for pain 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Methadone Guidelines and Vomited Doses
- There are no specific studies that directly address the replacement of vomited methadone doses as per methadone guidelines.
- The provided studies focus on various aspects of methadone use, such as overdose risks 2, 3, expanded take-home access 4, discontinuation of methadone treatment 5, and methadone induction in emergency departments 6.
- None of these studies provide information on the replacement of vomited methadone doses, suggesting a lack of research on this specific topic.
Related Methadone Studies
- A study on methadone overdose found that symptoms typically occur within 9 hours of ingestion, with a mean onset of 3.2 hours 2.
- Another study highlighted the risks of methadone overdose and the need for healthcare providers to follow consensus guidelines for appropriate opioid prescribing 3.
- Research on expanded take-home access for methadone treatment found that patients perceived benefits, including increased autonomy and treatment flexibility 4.
- A qualitative study on discontinuing methadone treatment identified internal and external reasons for patients' decisions to stop treatment, including views on methadone as a bridge to recovery and concerns about stigma 5.
- A case report described a patient who completed a same-day methadone induction in an emergency department, highlighting the feasibility of emergency department-initiated methadone treatment 6.