Craving despite extremely high methadone dosage.
A clinical case study is presented of an opiate addict, currently under methadone maintenance treatment (MMT), who claims the need of a higher daily methadone dose. He is admitted to a closed metabolic ward, where he receives 250 mg methadone per day. During 24 h both pharmacokinetic parameters and craving levels are measured simultaneously. Results show extremely high methadone concentrations and its primary metabolite EDDP in plasma and urine. The craving level shows a distinguished peak around the methadone administration on both measured days. Withdrawal symptoms as well as self-reported craving did not correspond at all to the extremely high methadone concentration level in plasma. So we suggest that in individual cases if high methadone doses and plasma methadone levels are not able to diminish craving symptoms, dose adjustment should be accompanied by education regarding daily anticipatory increase of opiate craving.
de Vos
J W
JW
Academic Medical Centre, University Of Amsterdam, Department of Pharmacology, The Netherlands.
Ufkes
J G
JG
van Brussel
G H
GH
van den Brink
W
W
D004305:Dose-Response Relationship, Drug; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate / Q000502:physiology; D008691:Methadone / Q000008:administration & dosage* / Q000493:pharmacokinetics; D008875:Middle Aged; D009042:Motivation; D009460:Neurologic Examination / Q000187:drug effects; D009293:Opioid-Related Disorders / Q000097:blood / Q000523:psychology / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology; D010353:Patient Education as Topic; D013375:Substance Withdrawal Syndrome / Q000097:blood / Q000175:diagnosis* / Q000523:psychology
D008691:Methadone