title: Methadone complications amongst opioid-dependent patients in Malaysia: A case series.
abstract: OBJECTIVE
  Opioid dependence remains the main type of illicit substance used in Malaysia, which has an estimated 187 771 opiate users. There are currently 333 active methadone maintenance treatment centres nationwide. Although methadone has proven to be an effective maintenance therapy, it has clinical concerns which can have an impact on its effectiveness and safety.
  
  
  METHODS
  A case series of seven patients from Malaysian private and public hospital settings who had an adverse reaction with methadone is discussed.
  
  
  CONCLUSIONS
  Despite methadone being an effective therapy for opioid dependence, there is a need for other alternative effective therapies, such as naltrexone, buprenorphine and the co-formulation of buprenorphine-naloxone, to be made available to physicians in both public and private sectors. There is need for individual treatment consideration to avoid adverse effects, drug-drug interactions, overdosing and in the presence of co-morbidities. An emphasis on safe storage of takeaway methadone is also needed. [George P, Vicknasingam B, Thurairajasingam S, Ramasamy P, Mohd Yusof H, Yasin MABM, Shah ZUBS. Methadone complications amongst opioid-dependent patients in Malaysia: A case series. Drug Alcohol Rev 2018;37:147-151].
authors.affiliation: School of Medicine, International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Philip
authors.initials: P
authors.lastname: George
authors.affiliation: Centre for Drug Research, Universiti Sains, George Town, Malaysia.
authors.forename: Balasingam
authors.initials: B
authors.lastname: Vicknasingam
authors.affiliation: School of Medicine, Monash University, Subang Jaya, Malaysia.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Thurairajasingam
authors.affiliation: Hospital Kuala Pilah, Kuala Pilah, Malaysia.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Ramasamy
authors.affiliation: Hospital Permai, Johor Bahru, Malaysia.
authors.forename: Haslina
authors.initials: H
authors.lastname: Mohd Yusof
authors.affiliation: School of Medicine, Monash University, Subang Jaya, Malaysia.
authors.forename: Mohd Azhar Bin Mohd
authors.initials: MABM
authors.lastname: Yasin
authors.affiliation: School of Medicine, International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Zia U Bahkt Sultan
authors.initials: ZUBS
authors.lastname: Shah
mesh_terms: D000328:Adult; D002675:Child, Preschool; D062787:Drug Overdose; D004487:Edema / Q000139:chemically induced; D005260:Female; D006801:Humans; D008296:Malaysia; D008297:Male; D008691:Methadone / Q000009:adverse effects* / Q000627:therapeutic use; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011537:Pruritus / Q000139:chemically induced
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: adverse effect; interaction; methadone; methadone poisoning; opioid dependence