From the Guidelines
Methadone has a minimal effect on blood pressure, with most patients experiencing small increases of approximately 5-10 mmHg in systolic pressure and 3-7 mmHg in diastolic pressure, particularly during the initial stages of treatment or after dose increases. This effect is likely due to methadone's impact on the autonomic nervous system and mild vasoconstriction, similar to other opioids 1. The study published in the Journal of the National Comprehensive Cancer Network in 2019 highlights the complexities of methadone usage, including its long half-life and interindividual variations in pharmacokinetics, but does not specifically address its effects on blood pressure 1. However, it is essential to monitor patients with pre-existing hypertension more closely when starting methadone therapy, as they may be more susceptible to blood pressure changes.
Some key points to consider when prescribing methadone include:
- Monitoring for drug accumulation and adverse effects, particularly over the first 4 to 7 days, as recommended by the NCCN Guidelines 1
- Providing patients with access to adequate, short-acting, breakthrough pain medications during the titration period 1
- Being aware of the potential for QTc prolongation and torsades de pointes, particularly at high doses of methadone (120 mg and above) 1
- Considering the individual variations in methadone pharmacokinetics and adjusting the dose accordingly 1
It is also important to note that the cardiovascular effects of methadone are generally less pronounced than those of other opioids, making it a preferred option for long-term maintenance therapy 1. If significant blood pressure elevation occurs, dose adjustment or additional antihypertensive medication may be necessary, but this is uncommon with standard therapeutic doses. Overall, methadone's effect on blood pressure is typically minimal and manageable with proper monitoring and dose adjustment.
From the FDA Drug Label
In addition, reductions in serum testosterone levels and sperm motility, and abnormalities in sperm morphology have been reported. Patients should be cautioned that methadone, like other opioids, may produce orthostatic hypotension in ambulatory patients. The administration of methadone may result in severe hypotension in patients whose ability to maintain normal blood pressure is compromised (e. g., severe volume depletion). Other symptoms also may develop, including: ... increased blood pressure...
The effect of methadone on blood pressure is that it may produce orthostatic hypotension in ambulatory patients and severe hypotension in patients with compromised ability to maintain normal blood pressure. However, it may also cause increased blood pressure in some cases. 2, 2, 2
From the Research
Effect of Methadone on Blood Pressure
- Methadone maintenance treatment (MMT) may lead to an increase in blood pressure (BP) in some patients, with hypertension (HTN) detected in 36.3% of current patients 3.
- The increase in BP was associated with weight gain, and patients who succeeded in drug abstinence during MMT were more likely to experience BP elevation 3.
- Methadone overdose has been shown to decrease peripheral and aortic systolic, mean and end systolic pressures, as well as peripheral pulse pressure 4.
- Dihydrocodeine and methadone both reduced cardiac afterload, which may provide a pharmacological explanation for the apparent benefit of opioids in cardiovascular diseases 4.
- There is no direct evidence to suggest that methadone has a significant effect on blood pressure in the general population, but it may have cardiotoxic effects, including QT interval prolongation and torsade de pointes, which can be life-threatening 5, 6.
Factors Influencing the Effect of Methadone on Blood Pressure
- Methadone dose and serum levels did not have a significant impact on the increase in BP in patients with HTN 3.
- Weight gain and drug abstinence during MMT were associated with an increase in BP 3.
- The pharmacokinetics of methadone can vary greatly from person to person, which may affect its impact on blood pressure 7.
- Methadone can interact with other drugs, including antiretrovirals, which can decrease its levels and cause withdrawal symptoms 7.