Methadone Injection

Why is this medicine prescribed?

Methadone injection is used to relieve severe pain. Methadone also is used to treat opioid addiction (physical and psychological reliance on a chemical found in prescription and street drugs). Methadone is in a class of medications called opiate (narcotic) analgesics. Methadone works to treat pain by changing the way the brain and nervous system respond to pain. It works to treat people who were addicted to opiate drugs by producing similar effects and preventing withdrawal symptoms.

Are there other uses for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Methadone injection comes as a solution (liquid) to inject subcutaneously (just under the skin), intramuscularly (into a muscle), or intravenously (into a vein). Inject once every 8 to 12 hours. When methadone injection is used to prevent withdrawal symptoms, it is given by a doctor or nurse in a medical facility.

Your doctor may change your dose of methadone during your treatment. Your doctor may decrease your dose or tell you to use methadone injection less often as your treatment continues. If you experience pain during your treatment, your doctor may increase your dose or may prescribe an additional medication to control your pain. Talk to your doctor about how you are feeling during your treatment with methadone injection. If you feel that your pain is not controlled or if your pain increases, becomes worse, or if you have new pain or an increased sensitivity to pain while you are using methadone injection, call your doctor. Do not use extra doses of methadone injection or use doses of methadone injection earlier than they are scheduled even if you experience pain.

Talk to your doctor or pharmacist about access to rescue medicines, naloxone or nalmefene,while receiving methadone injection. Rescue medications can reverse the life-threatening effects of anopioid overdose and are available over the counter or with a prescription. Make sure that youand your family members and people usually around you know how to recognize an overdose,how to use naloxone or nalmefene, and what to do until emergency medical help arrives. Yourdoctor or pharmacist will show you and others how to use it. If symptoms of an overdose occur,they should give the first dose of naloxone, call 911 immediately, and stay with you and watchyou closely until emergency medical help arrives. If your symptoms return, the person shouldgive you another dose of the rescue medication. Additional doses may be given every 2 to 3minutes, if symptoms return before medical help arrives.

Do not stop using methadone injection without talking to your doctor. Your doctor will probably want to decrease your dose gradually. If you suddenly stop using methadone, you may experience withdrawal symptoms such as restlessness, teary eyes, runny nose, yawning, sweating, chills, muscle pain, widened pupils (black circles in the middle of the eyes), irritability, anxiety, backache, joint pain, weakness, stomach cramps, difficulty falling asleep or staying asleep, nausea, decreased appetite, vomiting, or diarrhea.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

What special precautions should I follow?

Before using methadone injection,

• tell your doctor or pharmacist if you are allergic to this drug, any part of this drug, or any otherdrugs, foods or substances. Tell your doctor or pharmacist about the allergy and whatsymptoms you had.

• some medications should not be taken with methadone injection. Make sure you have discussed anymedications you are currently taking or plan to take before starting methadone injection with your doctorand pharmacist. Before starting, stopping, or changing any medications while using methadone injection,please get the advice of your doctor or pharmacist.

• tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, or tranylcypromine.

• the following nonprescription or herbal products may interact with methadone: St. John's wort and tryptophan. Be sure to let your doctor and pharmacist know that you are taking these medications before you start using methadone injection. Do not start this medication while using methadone injection without discussing it with your healthcare provider.

• tell your doctor if you have slowed breathing, asthma, chronic pulmonary disease (COPD), or other lung problem or have or have ever had a blockage in your intestine or paralytic ileus (condition in which digested food does not move through the intestines) or a blockage in the stomach or intestines. Your doctor may tell you that you should not use methadone injection.

• tell your doctor if you have or have ever had long QT syndrome or if you have or ever had a slow or irregular heartbeat, a brain tumor, or any condition that increases the amount of pressure in your brain; seizures; or thyroid, pancreas, gallbladder, heart, liver, or kidney disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If youbecome pregnant while receiving methadone, call your doctor.

• you should know that this medication may decrease fertility in men and women. Talk to your doctor about the risks of using methadone injection.

• you should know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.

• you should know to not drink alcoholic beverages while you are receiving methadone injection. Alcohol can make the side effects from methadone worse.

• you should know that methadone may cause dizziness when you get up too quickly from a lying position. This is more common when you first start using methadone injection. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

• you should know that methadone may cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are using methadone injection.

What special dietary instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What side effects can this medicine cause?

Methadone may cause side effects. Tell your doctor if any of these symptoms or those in the SPECIAL PRECAUTIONS section are severe or do not go away:

• headache
• nausea, vomiting
• sweating
• decreased sexual desire, inability to get or keep an erection
• pain or redness at injection site

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• seizures
• rash; hives; itching; hoarseness; difficulty breathing or swallowing; or swelling of the face, mouth, tongue or throat
• extreme drowsiness
• agitation, hallucinations (seeing things or hearing voices that do not exist), fever, sweating, confusion, fast heartbeat, shivering, severe muscle stiffness or twitching, loss of coordination, or diarrhea
• nausea, vomiting, loss of appetite, weakness, or dizziness
• new pain or pain from touch or doing ordinary tasks such as combing your hair
• chest pain, changes in heartbeat
• unusual snoring or long pauses during breaths during sleep
• difficulty swallowing, regurgitation (bringing up swallowed food into throat and mouth), pain in the chest area

Methadone injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, out of reach of children, and in a location that is not easily accessible by others, including visitors to the home. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Dispose of any medication that is outdated or no longer needed through a medicine take-back program. If you do not have a take-back program nearby or one that you can access promptly, flush any methadone injection solution that is outdated or no longer needed down the toilet. Talk to your pharmacist about the proper disposal of your medication.

Keep all medication out of sight and reach of children as many containers are not child-resistant. Always lock safety caps. Place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

What should I do in case of overdose?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• narrowing or widening of the pupils (black circles in the center of the eyes)
• slow or shallow breathing, difficulty breathing
• sleepiness, unable to respond or wake up
• drowsiness
• cool, clammy, or blue skin
• slow heartbeat

What other information should I know?

Keep all appointments with your doctor or clinic.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are using methadone injection.

This prescription is not refillable. If you continue to experience pain after you finish using methadone injection, call your doctor. If you take this medication on a regular basis, be sure to schedule appointments with your doctor so that you do not run out of medication.

Keep a written list of all of the prescription and nonprescription (over-the-counter) medicines, vitamins, minerals, and dietary supplements you are taking. Bring this list with you each time you visit a doctor or if you are admitted to the hospital. You should carry the list with you in case of emergencies.