methadone

jansgalRN · Sep 16, 2003

Very difficult, but effective when situation is ideal. The primary caregiver must be informed and very dependable. In my experiences, patients were switched from MS Contin to methadone. They have to be weaned simultaneously from the MS Contin as the Methadone dose is adjusted. Also, methadone is given tid instead of bid. Works well for neurological pain. Once methadone reaches effective level, methadone dose is adjusted to maximize pt. comfort. Usually, dose can be substantially decreased due to the sustained therapeutic plasma level. It can be quite involved and nurse is required to make daily visits to monitor patient response. I'm not sure if this is an individual policy or not. Hope this is helpful.

cargal · Sep 17, 2003

Hi everyone, I'm baaaack, hehe.

I am currently in the process of transitioning a pt (neurofibramatosis) from kadian 80 TID to methadone 30mgs BID, having not started yet. She states she was on methadone at one time, straight TID with no dose adjustment, but our Pharm consultant inserviced us and presented that the dose must be adjusted at day 59 as jansgalRN above stated because of toxic buildup, if I remember correctly. This would explain why the pt stated that at that time, she "didn't like the way it made her feel". Her pain is currently uncontrolled and agressive communication with the pain doc resulted in his trying our Pharm consultant method. Will let you know how this progresses!

cargal · Oct 12, 2003

Update:

The pain doc had not communicated with us as a homecare/hospice service. I left a voicemail for the nurse with our recommendations as stated above. Out of the blue the pain doc started her on methadone 60 TID without so much as a phone call to my company to inform us. She was sent to the ER with lethargy and sedation and sent home where she wanted to be converted back to Kadian. As I said, I was never informed of the change and could only attempt damage control. It was a disaster. Methadone should initially be monitored daily be a visit or a phone call. This was all done inconsistant with our pharm consult recommendations, then when all was said and done the doc FINALLY contacted me to put me in my place.

Oh well, can't lose them all- my patient still has faith in me and I have realized that I can't fix everything. This is one sad case.

More later.

Totone656 · Nov 15, 2003

We use methadone for our patient on the service the hospice company I work for. What is wonderful about this drug is that it can be compounded into a cream which helps those who have difficult swallowing or those whose nausea is not in control. With this compounded drug we have added other medications to it.

A patient which just recently passed had Prostate CA with mets to bone and brain, when he came onto service he was also having uncontrolled nausea and vomiting. We got with the pharmacist and came up with a PLO cream which took care of the pain and the nausea.

We have a wonderful pharmacist and are very thankful he has been able to compound methadone into a cream.

Midwestbabygirl · Nov 16, 2003

I am a Burn Nurse who is currently travelling. My "home" unit starts methadone on admission, whereas the hospital I am at now, doesn't even use it. I see a HUGE improvement in pain management for the patients who get it.