All things Methadone
All things Methadone
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Continuing/Restarting Inpatient
Continuing/Restarting Inpatient
Step 1:
Step 1:
Confirm outpatient methadone clinic with patient (list of NOCO methadone clinics) on admission.
Step 2:
Step 2:
Order COWS and comfort meds, baseline EKG.
Step 3:
Step 3:
Call clinic ASAP: “Hi I’m __________ calling from PVH about __________ to confirm their methadone dose, and the date of their last dose.”
Step 4: Start methadone!
Step 4: Start methadone!
Day 1:
- If patients have missed <4 days, restart at outpatient dose.
- If patients have missed >5 days, likely decrease 20-40%. Ask methadone clinic for dose reduction recs.
- If you cannot confirm dose (i.e. overnight) but patient has withdrawal symptoms, give 30 mg of methadone, other comfort meds (clonidine, hydroxyzine, oxycodone or IV dilaudid if NPO) until dose can be confirmed.
- Order additional methadone 10 mg once PRN 2-4 hours after initiation on day 1 for increasing COWS score
Days 2-4: Give total dose from day 1. Order additional 10 mg PRN as needed for withdrawal symptoms or cravings.
Day 5+: Once at 60-70 mg, increase by 10 mg every 3 days until therapeutic.
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