Methadone Hospital Quick Start - Inpatient Initiation for Opioid Use Disorder and Withdrawal
Initial Dosing:
 - Patients should be dosed according to tolerance. May use morphine equivalent calculator as a guide. Withdrawal severity is not well correlated with tolerance.
 - Can use adjunctive medications for withdrawal symptoms.
 - Order naloxone prn sedation/resp depression
Complicating Factors:
 - Allergy to methadone
 - Respiratory depression
 - Ramsay sedation scale ?3
 - QTc ?500
 - Recent use of benzodiazepines, alcohol or other sedatives
 - Severe liver disease
 - Medically unstable
 - If RR <8 or sedated, do not give additional methadone

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