Methadone background

Guideline background

There are no NICE guidelines on the use of methadone for pain therefore the specialist palliative audit and guidelines group (SPAGG) have developed these guidelines to ensure safe and consistent practice in line with local expert opinion.

A small number of patients with cancer experience pain that cannot be controlled by using the analgesic ladder even when antiepileptics and antidepressant drugs are added to opioid drugs.

Methadone has pharmacological specificities described in General drug information about methadone. In particular a long half-life and titration to an effective dose is often complex, therefore dose titration and modification should be carried out under the care and supervision of a specialist palliative care or pain team (See reference 1).

Recent guidelines and consensus papers have been published. We recommend that specialists and those wishing to safely prescribe methadone read these excellent documents. We have attempted to take account of their recommendations and cited some of them. They cannot be fully replicated for local guidelines as they operate in different clinical and health care systems than our (See reference 1, 2).

Disclaimer (SPAGG - Rewrite)

This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.