Levomethadyl Acetate HCl

A to Z Drug Facts

 Action Similar mechanism of action as other opiates; however, its slow onset and long duration of action make use as analgesic inappropriate.

 Indications Management of opiate dependence.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: PO Induction: 20 to 40 mg 3 times/wk on Monday-Wednesday-Friday or Tuesday-Thursday-Saturday schedule. Higher dose may be needed at end of week to prevent withdrawal symptoms over 72-hour break. Dose can be increased in 5 to 10 mg increments until steady state is reached, usually in 1 to 2 wk. Never give on daily basis; if needed, give small doses of methadone on “off” day. For patients dependent on methadone, initial dose of levomethadyl is 1.2 to 1.3 times daily methadone dose. Maintenance: 60 to 90 mg 3 times/wk (range: 10 to 140 mg/dose); higher doses may be needed. Planned interruptions in therapy: Take-home doses of levomethadyl are not permitted; give methadone instead. Unplanned interruptions in therapy: After single missed dose, restart on every-other-day schedule. Wait until after weekend 72-hour break to reestablish prior schedule. If > 1 dose is missed, restart at 50% to 75% of previous dose. After lapse of > 1 wk, restart using induction schedule.

 Interactions

Alcohol or drugs of abuse: Fatal overdose can occur; symptoms may be delayed. Other CNS depressants (eg, tranquilizers, sedatives): Additive CNS depression.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Hypertension; orthostatic hypotension; prolonged QT interval; nonspecific ST-T wave changes; peripheral edema. CNS: Drowsiness; insomnia; asthenia; nightmares; depression; euphoria; headache; nervousness. DERM: Sweating; pruritus; urticaria. GI: Nausea; vomiting; dry mouth; constipation; abdominal pain. GU: Urinary retention. RESP: Cough. OTHER: Tolerance; psychological and physical dependence with chronic use.

 Precautions

Pregnancy: Category C. Infants may develop neonatal abstinence syndrome. Recommend switching to methadone during pregnancy. Levomethadyl is not recommended for use in pregnancy. Lactation: Undetermined. Children: Not recommended in those < 18 yrs. Daily use: Administration of levomethadyl on a daily basis has led to excessive drug accumulation and risk of fatal overdose. Routine daily dosing after a patient has been inducted onto levomethadyl treatment is not allowed by current treatment regulations. Special-risk patients: Use with caution in patients with myxedema, acute alcoholism, acute abdominal conditions, ulcerative colitis, decreased respiratory reserve, head injury or increased intracranial pressure, hypoxia, supraventricular tachycardia, depleted blood volume or circulatory shock. Drug dependence: Has abuse potential. Renal or hepatic impairment: Duration of action may be prolonged; may need to reduce dosage or convert to methadone.

 Administration/Storage

• Drug may not be dispensed for outpatient use. May be used only by treatment programs approved by FDA, DEA and designated state authorities.
• Administer in oral form only. Always dilute before administration.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note renal or hepatic impairment or cardiac disease.
• Assess for hypertension or orthostatic hypotension, arrhythmias, peripheral edema and cough.
• Carefully monitor patients with cardiac disease or those receiving medications that affect cardiac conduction.
• Observe for withdrawal symptoms. Dosage may need to be adjusted to prevent unpleasant symptoms.
• Monitor I&O during therapy. Increasing fiber, fluids and exercise may help prevent constipation.
• Provide good oral hygiene.
• Be alert to palpitations, syncope, or other symptoms suggestive of episodes of irregular cardiac rhythm in patients and promptly evaluate such cases.

 Patient/Family Education

• Advise patient that full effectiveness of drug may not occur for several days.
• Warn patient that drug may cause dependence and that detoxification/withdrawal program will be necessary if drug is discontinued.
• Advise patient that drug may cause drowsiness or impair judgment and to use caution while driving or performing other tasks requiring mental alertness.
• Remind patient to notify physicians, dentists and other health care providers of drug regimen.
• If patient is switching from levomethadyl to methadone, advise patient to wait 48 hours after the last dose of levomethadyl before taking the first dose of the other narcotic.
• Instruct patient to avoid intake of alcoholic beverages or other CNS depressants.
• Instruct patient not to take otc medications without consulting physician.
• Encourage patient to wear identification bracelet or necklace and carry ID card.
• Emphasize importance of comprehensive treatment to include medical evaluation, planning and counseling.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts