Methadone Hypotension | CNS Depression
Methadone may also cause severe hypotension and should be used cautiously in case of severe volume depletion or abnormal blood pressure, cardiovascular disease or dysrhythmias.
Methadone may also cause respiratory depression and care must be taken when used in patinets with respiratory disease or pre-existing respiratory conditions such as severe obesity, asthma, COPD, sleep apnea, or CNS depression. Since the respiratory effects last longer than the analgesic effects, slow titration of methadone doses is required. Attention and care should be emphasized when initiating methadone treatment on dose titration and conversion from other opioid agonists. Incomplete cross tolerance may occur patient may not be tolerant to methadone even though tolerant to other mu opioid agonists. Abrupt cessation must be avoided as may precipitate withdrawal symptoms.
Methadone may cause CNS depression which impair physical or mental abilities and thus should be cautioned in performing tasks requiring mental alertness such as operating machinery or driving after taking methadone. Sedative drugs or ethanol may potentiate methadone effects. Use with caution in patients with depression or suicidal tendencies or history or drug abuse. Psychological and physical dependence may occur with prolonged use.
Also, patient with head injury or increased intracranial pressure must be taken extra care. Patients with acute abdominal conditions may obscure diagnosis or clinical course.. Elderly patients is more susceptible to methadone side effects such as CNS, respiratory and gastrointestinal effects and hence, lower initial dose should be used in elderly or debilitated, or in patients with abnormal thyroid metabolism, obesity, adrenal insufficiency, prostatic hyperplasia or urethral stricture and also in impaired renal and hepatic function.
It must be noted that safety and efficacy of methadone use has not been established in children.
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