From the Guidelines
The typical methadone dose for opioid use disorder is between 60 to 120 mg per day, with most patients stabilizing between 80-100 mg daily. This dose range is based on the most recent and highest quality study available, which emphasizes the importance of individualized dosing to control withdrawal symptoms and cravings without causing adverse effects 1.
When initiating methadone treatment, it is crucial to start with a lower dose, typically 20-30 mg on the first day, to assess tolerance and gradually increase by 5-10 mg every few days as needed. Methadone's long half-life, ranging from 24 to 36 hours, necessitates cautious dose adjustments to prevent accumulation and potential overdose.
Key considerations in methadone dosing include:
- Starting with a low dose to assess tolerance
- Gradually increasing the dose to control withdrawal symptoms and cravings
- Individualizing the maintenance dose based on patient response
- Monitoring for adverse effects, such as sedation or QTc prolongation
- Regular clinical assessment and occasional drug testing throughout treatment
It's also important to note that methadone is typically dispensed through specialized opioid treatment programs, requiring initial daily clinic visits, with the possibility of take-home doses as treatment progresses and stability is demonstrated. The goal of methadone treatment is to provide a stable level of opioid activity that prevents withdrawal symptoms while blocking the euphoric effects of other opioids, thus supporting recovery from opioid use disorder.
From the FDA Drug Label
The initial methadone dose should be administered, under supervision, when there are no signs of sedation or intoxication, and the patient shows symptoms of withdrawal. Initially, a single dose of 20 to 30 mg of methadone will often be sufficient to suppress withdrawal symptoms The initial dose should not exceed 30 mg. Most commonly, clinical stability is achieved at doses between 80 to 120 mg/day
The typical methadone dose for opioid use disorder is:
- Initial dose: 20 to 30 mg, not to exceed 30 mg
- Maintenance dose: 80 to 120 mg/day, to prevent opioid symptoms for 24 hours and reduce drug hunger or craving 2
From the Research
Methadone Dosing for Opioid Use Disorder
- The typical methadone dose for opioid use disorder can vary, but studies suggest that a goal for methadone dosing is in the range of 60 to 100 mg daily 3.
- For patients who continue to use illicit opiates while prescribed this dose range, clinicians may consider doses greater than 100 mg daily, although this is not the current consensus 3.
- Higher doses of methadone, such as 120 mg, have been shown to produce superior opioid blockade and comparable withdrawal suppression to lower doses in opioid-dependent humans 4.
- In some cases, patients may be transitioned from methadone to buprenorphine, with methadone doses ranging from 40-100 mg/day and buprenorphine doses ranging from 12-16 mg/day 5.
Factors Influencing Methadone Dosing
- Patient characteristics, such as stability or controlled medical or psychiatric comorbidities, and a safe, substance-free environment, can influence methadone dosing 6.
- The use of take-home methadone doses has been impacted by COVID-19-related policy changes, with some opioid treatment programs (OTPs) allowing increased take-home doses for newly enrolled, "less stable," and "stable" patients 7.