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Methadone in palliative care

Rongoā methadone ki te manaakitanga whakamaene

This page is about taking methadone for pain in palliative care. It is not about taking methadone as part of the opioid substitution programme.

Important

Take your medication as directed. Contact your community nurse or other health professional if your pain is not controlled or if you or your whānau have any concerns.

If you are unable to contact your regular health professional and have serious concerns, call 111.

Methadone is a medicine like morphine that works as a strong pain reliever. Doctors prescribe methadone when someone has strong pain.

In palliative care, the time to start using methadone is when your pain is bad enough. It does not mean you are dying.

Methadone only helps some types of pain, and you may need to take other pain relief medicines as well. Your doctor will discuss this with you.

You may need to steadily increase the dose of methadone to work out the right dose. Your doctor will do this slowly and steadily over a few days, sometimes taking up to 2 weeks to get the right dose. As your illness progresses, you may need to increase the dose. But this usually happens because the pain is getting worse. It does not mean that the methadone is losing its effect.

When used correctly at the right dose, there is no evidence that methadone either shortens or prolongs life.

Taking methadone

You can take methadone as a tablet or a solution.

For methadone tablets, follow the instructions and take them with a glass of water.

For methadone solution, measure it and take it according to the instructions.

You must only take the amount of methadone you have been prescribed and at the times on your instructions. If this does not control your pain, talk to your healthcare professional.

If you miss a dose, take it as soon as possible. But if it is almost time for your next dose, skip the missed dose and continue as usual from your next dose. Do not take 2 doses at once.

To help avoid missing doses or taking extra ones, use a notebook to keep track of when you take each dose of methadone.

If you are forgetful, have someone else give you each dose of methadone and keep a record of it.

Possible side effects

Constipation

Although methadone is a good pain reliever, almost everybody who takes it gets constipated. You should make sure your doctor routinely prescribes a good laxative, which you need to take regularly. You can also help to ease this by eating more fruit, vegetables, brown bread and bran-based breakfast cereals. And by drinking plenty of liquids.

Nausea and vomiting

About a third of people starting methadone can feel sick or even throw up in the first week to 10 days of treatment. Fortunately, this usually goes away. If this is a problem for you, your doctor can prescribe an anti-sickness tablet. Bear in mind that other things might be causing your nausea and vomiting – it may not be the methadone. Talk to your doctor or nurse if you are having problems.

Drowsiness

Sometimes people feel more sleepy or drowsy than usual for a few days after starting methadone or increasing the dose. This usually wears off quickly. If methadone affects you in this way, you must not drive or operate dangerous machinery.

Less common side effects when taking methadone include unsteadiness, confusion and hallucinations. Also, sweating, blurred vision, shaking, difficulty passing urine and a dry mouth. If you experience any of these, tell your doctor.

Methadone addiction

Addiction can happen when people take opioid medicine for a long time or if they abuse opioid medicines.

It is sometimes possible to reduce your methadone dose if another treatment can relieve your pain. If you need to reduce or stop your methadone, make sure you talk to your doctor about it. Your doctor will reduce your dose gradually to reduce the risk of withdrawal symptoms.

If you need to take higher and higher doses, it may be because your body is getting used to the methadone or because your disease is getting worse. It does not mean you are becoming addicted.

Driving

Taking methadone does not automatically mean you cannot drive. You need to talk to your doctor about this. But if you have difficulty staying alert or concentrating, or if you are physically weak or ill, it is not wise to drive. If your doctor says driving is OK, follow these general guidelines:

do not drive in the dark or in bad conditions
do not drink any alcohol before driving
do not exhaust yourself by driving long distances
talk to family and friends about any concerns you have
do not drive within 4 hours of taking a dose of methadone
do not drive if you are in severe pain.

Remember – the risk lies with you. If you are involved in an accident, you will be questioned closely if you seem to be under the influence of drugs.

Alcohol

The combination of methadone and alcohol will probably make you feel sleepy or drunk much sooner than usual. So, it is sensible to drink less than you are used to until you know what effect it has on you.

Recording your methadone use

Keep a diary of the doses and times of any medications you take for any breakthrough pain and any changes to your medication. Have this available for your community nurse or general practice team each time you see them. Also record how often you pass a bowel motion (poo).

Written by medical staff, Canterbury Integrated Palliative Care Services. Adapted by HealthInfo clinical advisers. Last reviewed October 2024.

Sources

The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public

Canterbury Community HealthPathways – Cough in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Dyspnoea in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Pruritus (itch) in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Weakness and fatigue in palliative care, retrieved December 2016.

Canterbury DHB – Palliative care guidelines (http://cdhb.palliativecare.org.nz/4207.htm), retrieved August 2016.

Nurse Maude – Symptom management (https://www.nursemaude.org.nz/wp-content/uploads/2023/02/Symptom-Management-2020-LR.pdf), retrieved December 2016.

Palliative Care Australia – Facts about morphine and other opioid medicines in palliative care, retrieved February 2017.

Palliative Care Australia – Learn more about pain and pain management, retrieved February 2017.

South Island Alliance – Health of older people useful resources (https://www.sialliance.health.nz/programmes/health-of-older-people/useful-resources/), retrieved September 2022.

UpToDate – Managing pain when you have cancer, retrieved February 2017.

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Review key: HIPAL-17434