Methadose is a brand name of the synthetic opioid methadone. Methadose is an analgesic pain reliever. It’s commonly prescribed to treat pain and for maintenance therapy, thereby helping opioid-dependent individuals gradually reduce their drug reliance. Methadose has a slow-onset and long duration of action which makes it ideal for the management of opioid misuse.
Methadose can take up to five days before enough of the drug builds up in the patient’s body to achieve maximum effects. The terminal elimination of Methadose is also slow, leading to less severe withdrawals when compared to other opioids.
Methadose has a high overdose potential and is also highly addictive. These traits are shared with all opioids. It’s imperative to take Methadose only as prescribed and to avoid mixing it with other substances. Other central nervous system depressants such as benzodiazepines greatly increase the likelihood of overdose when combined with Methadose.
Symptoms of Methadose overdose include severe respiratory depression, pinpointed pupils, and somnolence progressing to a stupor or coma. This is referred to as the “opioid overdose triad”; observed together, these symptoms signify the patient’s life is at risk, especially if emergency medical care is not close at hand.
The instinct to breathe is controlled by carbon dioxide levels in the blood. The brain stem is responsible for recognizing elevated carbon dioxide levels and triggering the body to breathe. In the event of a Methadose overdose, this drive can become entirely suppressed. The result is respiratory and circulatory failure, pulmonary edema, hypoxia, coma, and death.
Pinpoint pupils can transition to maximal dilation with the onset of hypoxia (oxygen deprivation). As opioid toxicity in the body progresses, the patient can rapidly deteriorate from responding in full sentences to being completely unaware of their surroundings.
Other signs of opioid overdose include skeletal-muscle flaccidity, bradycardia (slow heart rate), hypotension (low blood pressure), and purple/blue fingernails and lips.
Methadose is available as an oral tablet in standard 40 mg doses. The amount of Methadose necessary to cause an overdose varies greatly between patients because everyone’s metabolism is unique. Some people process opioids like Methadose significantly faster than others. Factors that influence Methadose metabolism include the patient’s, weight, body fat percentage, age, kidney and liver health, opioid tolerance, and specific genetic mutations.
Larger patients typically require high doses of the drug in order for it to reach toxic levels. The same dose that operates at therapeutic levels for an obese patient may present severe complications in a smaller individual. Age is a factor primarily due to suboptimal function of the liver and kidneys in older patients. It should be noted, however, that patients at any age with a history of liver and kidney failure may be contraindicated for Methadose use. One of the most influential factors is pre-existing opioid tolerance. As the body acclimates to the regular presence of the drug, higher doses may be needed to achieve the desired effects.
The priorities for Methadose overdose treatment are first and foremost to secure and protect the patient’s airway. Respiratory depression and flaccidity of the smooth muscles can lead to ineffective ventilation. Assisted or controlled ventilations may be necessary to ensure adequate oxygenation and avert hypoxia. If too much time passes before adequate oxygenation returns, the patient may suffer permanent effects, including paralysis and brain damage.
Oxygen therapy will likely be administered along with the use of a bag-valve mask or the placement of an endotracheal tube to assists ventilations. As overdose symptoms progress, the smooth muscles in the patient’s vasculature may begin to collapse. Additional supportive measures may be required to manage pulmonary edema and circulatory shock.
In the event of clinically significant respiratory depression, an opioid antagonist will need to be administered to reverse the effects of Methadose. Naloxone is the most commonly used opioid antagonist in the emergency room setting. Following intranasal or intravenous administration, it can fully negate the activity of Methadose in a matter of seconds.
Naloxone accomplishes this feat by breaking Methadose’s bond to opioid receptors in the body. In cases of severe overdose, multiple doses may be necessary. Because of Methadose’s long duration of action, the patient’s breathing will need to be closely monitored for the return of respiratory depression. The use of an opioid antagonist can precipitate the onset of severe post-acute withdrawals.
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