Mental Health  |  OST Drug Issues Pathway - Methadone Side Effects




Mental Health

OST Drug Issues Pathway - Methadone Side Effects

Some of these side effects may be confused with withdrawal symptoms and may be experienced even when the dose is appropriate. Serum level tests may be of assistance in determining adequacy of dose.

Side effects

Notes

Interventions/advice

Aching muscles and joints

Some individuals report rheumatic type pains and 'bone pain' - uncommon

Medical examination for any underlying pathology. Hot Epsom salts bath may ease symptom

Analgesia and hypo-analgesia

Systemic analgesia, long term can lead to opiate receptor saturation and hypo-analgesia or increased pain sensation

Advise patient to be extra careful when dealing with hot objects/fluids (e.g. when cooking)

Constipation

A common side effect

Increase intake of water and fiber and increase exercise. If necessary take regular Lactulose or Movicol

Galactorrhoea

Due to mildly/moderately increased prolactin levels

Check prolactin level and rule out pathology. Seek specialist endocrinologist advice if uncertain

Irregular menstrual cycle/amenorrhoea

Common in women who take opioids

Educate women about the risk of pregnancy despite menstrual irregularity/amenorrhoea

Lowered sex drive and impotence

Common with all opioid use

Reduce dose but needs to be weighed against compromising outcomes on MMT

Oedema

Fluid retention, puffiness, swelling, particularly of feet & ankles - uncommon

Usually resolves within a few weeks of starting treatment

Other G.I effects

Include:

Nausea and vomiting

Reduced gastric emptying

Elevated pyloric sphincter tone

Biliary tract outflow effects (can result in biliary spasm)

Loss or increased appetite

To reduce nausea and vomiting, suggest patient eat before consuming dose and drink dose slowly

Other symptoms may be reduced by reducing the dose

 

Increased Perspiration

Common especially at peak serum levels

 

Q-T prolonging effect

Slight risk, increasing with length of time taking methadone

Annual ECG tests recommended. See medications also with QT prolonging effects

Sedation

Drowsiness may be experience at peak serum level (3 to 4 hours after dose) especially during

initial stabilisation

Check serum levels

Reduced dose or split dose may be necessary - see relevant sections

Shallow breathing

From the respiratory depressive action of opioids

Reduce dose

Skin rash/itching

 

Appropriate skin lotion, e.g. BK lotion or similar emollient, antihistamine

Tooth decay/dry mouth

Opioids reduce the production of saliva

 

Increase fluid intake

Chew sugar free gum

Regular flossing and tooth brushing

Regular dental checks

Weight gain

Occurs in small number of patients

Assistance with weight management strategies

Weight loss

Lack of appetite, may be associated with mood

Assistance with weight management strategies


*See Section 6.2 Managing Side Effects page 44 and Appendix 4 Side Effects page 101 of
 " New Zealand Practice Guidelines for Opioid Substitution Treatment 2014"



Last updated : Wednesday, November 11, 2015
Next review date : Thursday, November 10,2016


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