From the Guidelines
Methadone is typically administered orally, with the most common routes being liquid solution, tablet, or dispersible tablet, and can also be given parenterally in hospital settings when oral administration is not possible. The oral route is preferred due to its steady blood levels, good bioavailability, and ability to allow for supervised dosing in treatment programs 1. For maintenance treatment of opioid use disorder, methadone is usually started at 20-30mg daily and adjusted based on individual response. In pain management, oral methadone is typically dosed every 8-12 hours. Methadone can also be administered intravenously, intramuscularly, or subcutaneously in hospital settings, although these routes are less common. The long half-life of methadone, ranging from 8 to over 120 hours, makes its usage complex and requires careful dosing and monitoring, especially in patients with cancer or those taking other medications that may interact with methadone 1.
Some key considerations for methadone administration include:
- Initial screening with electrocardiogram to identify heart rate corrected QT (QTc) prolongation for all patients on methadone, with interval follow-up with dose changes 1
- Splitting methadone into 6- to 8-hour doses to lengthen the active analgesic effects and achieve continuous pain control 1
- Monitoring for drug accumulation and adverse effects, particularly over the first 4 to 7 days, and caution that a steady state may not be reached for several days to 2 weeks 1
- Providing access to adequate, short-acting, breakthrough pain medications during the titration period 1
It is essential to note that methadone's usage should be carefully managed, especially in patients with complex medical conditions or those taking other medications that may interact with methadone, and should be started by or in consultation with an experienced pain or palliative care specialist 1.
From the FDA Drug Label
Methadone Hydrochloride Oral Concentrate is for oral administration only. The route of administration of methadone (Dolophine) is oral.
- The preparation must not be injected. 2
From the Research
Route of Administration of Methadone
The route of administration of methadone (Dolophine) can vary depending on the specific use case.
- Oral administration is commonly used for chronic pain management and opioid maintenance therapy 3, 4, 5, 6.
- Intravenous administration is sometimes used in acute pain management, particularly in intraoperative settings 4.
- Sublingual administration is not typically used for methadone, but it is used for buprenorphine, another opioid agonist 7.
Specific Administration Routes Mentioned in Studies
- Oral methadone is used as a second-line opioid treatment for select chronic pain conditions 4.
- Intravenous methadone has been reported to result in lower pain scores and post-operative opioid requirements in acute pain management 4.
- Methadone can be administered in scheduled divided doses every 4-8 hours or by continuous intravenous infusion for analgesia in patients on methadone maintenance therapy 3.