Methadone

Methadone is not suitable for everyone. For example, check it's OK to take with your doctor if you have lung or breathing problems.

Methadone comes as a liquid that you take once a day. It also comes as tablets or injections. Follow the instructions that come with your medicine.

Common side effects of methadone include feeling or being sick. More serious side effects can happen in rare cases.

You may be able to take methadone when you're pregnant, but check with your doctor first.

You can usually take methadone when you're breastfeeding, but you'll usually be managed by a specialist team.

It can cause problems to take methadone with some other medicines, such as other opioids, medicines to help you sleep or antidepressants.

Most adults aged 18 years and over, and occasionally younger people, can take methadone for heroin dependence.

Methadone may not be suitable for some people. To make sure it's safe for you, tell your doctor or prescriber before starting methadone treatment if you:

• have ever had an allergic reaction to methadone or any other medicine
• have a lung condition, or breathing difficulties
• have ever abused or been dependent on alcohol, prescription medicines or illegal drugs
• have a head injury or get bad headaches
• have ulcerative colitis
• have seizures or fits
• have heart disease, heart rhythm problems (arrhythmia) or low blood pressure
• have problems with your thyroid, adrenal glands, kidneys or liver
• have myasthenia gravis (a rare condition that causes muscle weakness)
• are pregnant, trying to get pregnant or breastfeeding

Methadone for heroin dependency usually comes as a green liquid that you swallow once a day.

It's best to swallow the medicine in one go. You can have a drink of water afterwards if you like.

How long to take it for

If you're taking methadone for maintenance therapy, you'll usually take it long term, as a substitute for heroin.

If you're taking it for detox, your dose will gradually be reduced until you do not need to take it anymore. This usually takes up to 12 weeks. It can sometimes be quicker, for example if you're detoxing in hospital or residential rehab.

You will stay on methadone until you decide to come off it. When you're ready to do this, your key worker will help you to reduce your dose of methadone gradually.

Stopping methadone

It's important not to stop taking methadone suddenly or without talking to your GP or prescriber first.

If you stop taking your methadone suddenly, you'll have withdrawal symptoms. These include feeling restless or anxious, a runny nose, sweating, feeling or being sick, diarrhoea and muscle cramps.

If you want to stop taking methadone, you'll need to make a new treatment plan. Your GP, prescriber or key worker will help you to reduce your dose very gradually. This is to help prevent withdrawal symptoms.

These common side effects of methadone happen to more than 1 in 100 people. There are things you can do to help cope with them:

Try to get more fibre into your diet by eating fresh fruit and vegetables and cereals. Drinking several glasses of water or other non-alcoholic liquid each day can help. If you can, it may also help to do some exercise.

If your symptoms do not go away, speak to a pharmacist or doctor about medicine to help prevent or treat constipation caused by methadone.

This usually wears off after a few days. Talk to your doctor if it carries on for longer.

If you feel sick, try taking your medicine with food. It may also help to avoid rich or spicy food. If you're being sick, try taking small frequent sips of water to avoid dehydration.

Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.

If you take the combined contraceptive pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

This usually wears off within a couple of weeks as your body gets used to methadone. Talk to your doctor, key worker or prescriber if these side effects carry on for longer.

Do not drive, cycle or use tools or machines if you're feeling tired or dizzy.

Make sure you rest and drink plenty of fluids. Ask your pharmacist to recommend a painkiller. If headaches are severe or do not go away, talk to your doctor.

Speak to your doctor, key worker or prescriber if this does not go away. They may need to adjust your dose.

This usually improves as you get used to methadone.

For dry eyes, ask a pharmacist for advice about eye drops called artificial tears. For a dry mouth, have frequent sips of water or other cold drinks.

Speak to your doctor, pharmacist or key worker if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

You may need to take methadone when you're pregnant, especially if it stops you from using heroin.

If you become pregnant while taking methadone, speak to your doctor or prescriber. They'll make sure you get a special care plan for you and your baby. You'll also get extra clinic visits from your doctor, midwife or key worker.

Your dose of methadone may need to be adjusted as your pregnancy progresses.

If you take methadone at the end of pregnancy, it may affect your baby. Your midwife will check your baby for withdrawal symptoms and arrange treatment in hospital if needed.

If your baby is healthy, you can usually take methadone if you're breastfeeding. You'll be managed by a specialist team who will help you decide.

Only small amounts of methadone pass into breast milk. It's important to keep taking your methadone to help reduce your withdrawal symptoms and heroin cravings.

Breastfeeding can benefit you and your baby. If you're taking methadone, it may also help to reduce your baby's withdrawal symptoms if they have any.

It's also important not to stop breastfeeding suddenly. This may cause babies to get withdrawal symptoms.

It's important not to share a bed with your baby while you're taking methadone.

It's very rare for breastfed babies to have side effects from medicines you're taking. But it's important to keep monitoring your baby if you're taking any medicine while breastfeeding.

Contact your healthcare professional or call 111 as soon as possible if you notice that your baby:

• is not feeding as well as usual or putting on weight as you would expect
• is unusually irritable
• has diarrhoea or is being sick
• has constipation
• has a rash

• seems unusually sleepy
• is having difficulty breathing
• seems unusually pale, sweaty or is shaky

Ask for advice about whether to keep breastfeeding and taking your medicine.

Do not drive to A&E. You can ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you or your baby takes with you.

If your baby has any symptoms that are not listed, or if you're worried about them, you can also call 111 or contact any healthcare professional.

Some medicines can affect the way methadone works and increase the risk of side effects or overdose.

Tell your doctor or pharmacist before starting on methadone if you take any other medicines, including:

• medicines to help you sleep, such as temazepam, zopiclone or zolpidem
• gabapentin or pregabalin
• antidepressants (particularly monoamine oxidase inhibitors such as tranylcypromine, phenelzine or isocarboxazid)
• medicines for anxiety or stress, such as lorazepam or diazepam
• medicine for heart rhythm problems, such as amiodarone, verapamil or diltiazem
• medicines to help you stop feeling or being sick, such as metoclopramide
• medicines for infections, including fungal infections
• medicines for HIV
• medicines for epilepsy, such as phenytoin or carbamazepine

These are not all the medicines that may cause problems if you take them with methadone. For a full list, see the leaflet inside your medicine packet.

Do not take morphine, buprenorphine, codeine or any other opioids while taking methadone.

It's usually OK to take methadone with paracetamol, ibuprofen or aspirin.

Do not take methadone with painkillers that contain codeine or dihydrocodeine. They make side effects more likely and increase the risk of overdose.

Some painkillers that you can buy contain codeine or dihydrocodeine along with other ingredients such as paracetamol, ibuprofen and aspirin. Some migraine treatments and cough syrups also contain codeine. Always check the ingredients on the packaging.

Speak to a pharmacist or a doctor before taking any painkillers, or if you need any advice about pain relief while taking methadone.