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    PCSS-M Clinical Guidances

    (click on links to download document)

     

     

    PCSS-M Guidance: Opioid Treatment Program Methadone Induction Dosing Updated 07/27/10

     

    PCSS-M Guidance: Methadone and Drug Interactions Updated 07/27/10

     

    Additional PCSS-M Clinical Guidances are in development.  Topics may include:

    • Pharmacology, pharmacokinetic and pharmacodynamic properties of methadone

    • Protocols for appropriate dose titration

    • Restarting methadone after brief cessation of treatment

    • Indications and strategies for split dosing and for dose adjustment

    • Use of serum methadone levels and peak dose monitoring

    • Methadone drug interaction and resources to check methadone drug interactions

    • Management of Psychiatric Medications in Patients Receiving Methadone

    • HIV Disease and Drug Interactions

    • Risk factors for respiratory depression in methadone treated patient

    • Concomitant use of sedatives and or alcohol

    • Pregnancy and Methadone Treatment

    • Methadone: cardiac considerations and

    • EKG monitoring

    • Decision tree for treating patients with a prolonged QTc interval

    • Methadone in combination with other drug that prolong the QTc interval

    • Torsades de pointes

    • Appropriate use of take-home doses or prescription refills

    • Diversion monitoring and use of urine drug of abuse screens

    • Prescription monitoring programs

    • Patient selection

    • Risks of following equalanalgesic tables rather than individualized methadone treatment

    • Managing polypharmacy in pain patients

    • Opioid tolerance and hyperalgesia

    • Universal precautions and sample treatment agreements in pain management

    • Pain Outcomes Profile and screening tools for addiction in pain patients

    • Identification of red flags and exit strategies and referral to alternative treatments

    • Responding to pressure to prescribe or increase the dose

    • Patient and family information

     

    Disclaimer for PCSS Clinical Guidances
    The PCSS Clinical Guidances have been developed as a resource for interested physicians, but the PCSS program is only a vehicle for the sharing of knowledge and information; it is not a referral mechanism. While it is expected that inquiries presented to mentoring physicians will be based on fact patterns related to actual cases, remarks and opinions from mentoring physicians should be understood as being general in nature and not directed at a specific patient or case. Opinions and counsel from a mentor should not be used as a substitute for the opinion, judgment, and knowledge of the treating physician. No physician-patient or other relationship, expressed or implied, is created between a mentoring physician and any patient by virtue of participation in the PCSS program.  

     

    page updated 02/10/10

     

     

     

     

     

     

     

     

     

     

     

         

     

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