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Methadone is a prescription opioid medication used for chronic pain management and as part of opioid use disorder (OUD) treatment programs. It works by binding to opioid receptors in the brain, helping reduce pain and prevent withdrawal symptoms and cravings in individuals recovering from opioid dependence. Methadone has a long duration of action, which makes it effective but also increases the risk of accumulation in the body if not carefully managed.

The dosage of methadone varies widely depending on whether it is used for pain relief or opioid dependence treatment. For pain, starting doses may be as low as 2.5 mg to 10 mg every 8–12 hours. For opioid dependence, initial doses typically range from 20 mg to 30 mg once daily, with gradual adjustments under strict medical supervision. Because methadone stays in the body for a long time, dose increases must be made slowly to avoid overdose.

Common side effects of methadone include drowsiness, dizziness, nausea, vomiting, constipation, sweating, and dry mouth. Some individuals may also experience weight gain, sexual dysfunction, or sleep disturbances. Serious side effects can include slow or shallow breathing, irregular heartbeat, fainting, or severe sedation, which require immediate medical attention.

There are critical warnings associated with methadone use. It carries boxed warnings for respiratory depression, misuse, and life-threatening heart rhythm problems such as QT prolongation. Combining methadone with alcohol, benzodiazepines, or other central nervous system depressants significantly increases the risk of fatal overdose. Methadone should be used cautiously in patients with heart disease, lung conditions, liver problems, or electrolyte imbalances. Pregnant or breastfeeding individuals should only use methadone under specialized medical care. Continuous medical monitoring is essential to ensure safe and effective treatment.