Monday, June 12, 2006

METHADONE FOR ANALGSIA: INSTRUCTIONS THAT CAN KILL

According to the Charleston (WVa) Gazette, the package insert for methadone tablets dispensed for analgesia give dosage instructions advising up to 10 mg every three to four hours. That's a potential total of 80mg on day one for a presumably nontolerant individual.- a dosage that unequivocally has lethal potential.

What could the company be thinking? Where's the FDA? .

10 Comments:

At 2:40 AM, Anonymous Anonymous said...

Bull crap Methadone save my life or should I said helped me live a half ass regular life to be pain free so I can be active in my kids growing up.

I take 120mgs a day.

 
At 10:44 PM, Blogger RGNewman, MD said...

of course methadone saves lives, and of coruse it can be given at dose of 120mg, or 220, or much higher. The issue is the dose ON DAY ONE, and the speed with which it's increased. Building up to 120 is great and totally safe. Giving 120 (or 80) on day one can be fatal. We really have no disagreement, I suspect.

 
At 3:41 PM, Anonymous Wil said...

If that is all the insert says, i.e., ... up to 10 mg every 3-4 hrs, I agree potential problems exist. However the problem I have is when fear-inducing spin doctors leave out detail and focus on worst case scenarios or the upper end of ranges (in this case 10 mg 8 times a day is the maximum recommended dose) when trying to make their point. The implied low end of the range is 1 mg 6 times a day - only 6 mg - neither fatal nor effective in treating any amount of pain. I doubt anyone receiving this med for pain has not received instruction from the doctor, the pharmacist, nor do I believe this insert has no detailed risk and precautionary statements about taking this drug. We need to stop looking to the government for protection of ourselves and blaming the government for everything that goes wrong. Sorry, but you don't sound like an MD.

 
At 2:38 PM, Blogger RGNewman, MD said...

thanks for the comment. Don't know whether "don't sound like an MD" is intended as a compliment or as a put-down :-) Anyway, the dosage range per the FDA-approved package insert for methadone for pain is 2.5-10mg every 3 to 4 hours. That means a total day one range of between 15 (not 6) and 80 mg. There's really no dispute that a starting dose of over 30-40 mg in 24 hrs can kill. So the problem of the package insert recommendation seems pretty clear.

You are of course 100% correct in worrying about physicians who are unwilling to provide adequate opiate pain medication; this has been a problem for decades. But I firmly believe the problem will be vastly vatsly worse when the media starts reporting that methadone prescribed for pain AS RECOMMENDED is killing patients. It will lead to ever more restrictive and punitive government crackdowns on physicians who treat pain, and in addition will cause physicians themselves to be even more unwilling to prescribe - not only will they face the wrath of govt but they will worry about killing their patients.

So . . . . do we have any disagreement? Thanks for writing about an issue that requires all the communication and discussion possible.

 
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