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Methadone is a medication with significant safety considerations that must be carefully managed to prevent serious health risks. Below are important safety guidelines and precautions to be aware of when using methadone:

• Risk of Misuse and Addiction: Methadone can be addictive and is subject to misuse. Take it only as prescribed and do not alter the dosage without consulting your healthcare provider. Those with a history of substance use disorder or mental health conditions may be at increased risk.

• Breathing Problems: Methadone can cause dangerously slow breathing (respiratory depression). This risk is highest when starting the medication, after a dose increase, or if taken with other substances that depress breathing, such as alcohol. Be cautious if you have medical conditions like COPD or asthma.

• Opioid Overdose Risk: Follow your prescription carefully to avoid overdose. Store methadone safely out of reach of children, pets, or visitors to prevent accidental ingestion.

• Drowsiness and Concentration Issues: Methadone can cause drowsiness and impair concentration. Avoid alcohol and other sedatives, as they can exacerbate these effects.

• Heart Rhythm Problems (QT Prolongation): Methadone may affect heart rhythm, leading to potentially life-threatening issues. Inform your healthcare provider of your full medical history and any medications you are taking.

• Drug Interactions: Methadone can interact with many medications. Always inform your healthcare provider about any other drugs you are taking to avoid harmful interactions.

• Pregnancy and Newborn Risks: Methadone can affect pregnancy and may cause withdrawal symptoms in newborns. Use during pregnancy only if absolutely necessary, and under medical supervision.

• Serotonin Syndrome: Combining methadone with certain medications can lead to serotonin syndrome, a rare but serious condition. Seek immediate medical attention if symptoms like rapid heart rate or confusion occur.

• Low Blood Pressure: Methadone can cause low blood pressure, leading to dizziness. Stand up slowly from sitting or lying positions to prevent falls.

• Adrenal Insufficiency: Long-term use of methadone may lead to low adrenal hormone levels. Report symptoms like fatigue, nausea, or dizziness to your healthcare provider.

• Seizure Risk: Methadone can increase the risk of seizures, particularly in individuals with a history of seizure disorders. Seek medical help if a seizure occurs.

• Low Blood Sugar: Although uncommon, methadone may cause low blood sugar in people with diabetes. Monitor blood sugar levels and manage symptoms promptly.

• Withdrawal Symptoms: Do not abruptly stop methadone if you are physically dependent, as withdrawal symptoms can occur. Consult your healthcare provider for a safe discontinuation plan.

Contraindications: Methadone should not be used in cases of severe respiratory depression, severe asthma, or gastrointestinal blockages. Consult your healthcare provider if these conditions apply to you.

In case of an overdose or if severe side effects occur, such as slow or shallow breathing, severe drowsiness, or irregular heartbeat, seek immediate medical assistance. Always keep naloxone available and ensure those around you know how to use it in an emergency.

Common side effects:

• nausea
• vomiting
• constipation
• lightheadedness
• dizziness
• dry mouth
• drowsiness
• sweating

Less common but important to monitor:

• headaches
• swelling
• itching
• rashes

Serious side effects:

• interrupted breathing during sleep
• changes in mood or mental state
• abdominal pain
• difficulty urinating
• unusual tiredness
• weight loss
• seizures
• severe drowsiness
• dangerously slow breathing
• unresponsiveness
• slow heartbeat
• serious allergic reactions
• severe dizziness
• trouble breathing

Interactions with high risk of serious adverse effects and should be avoided:

• MAO inhibitors (isocarboxazid, Linezolid, moclobemide, phenelzine, Selegiline)
• Cisapride
• Dronedarone
• Fluconazole
• Itraconazole
• Ketoconazole
• Pimozide
• Ziprasidone

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Mixed opioid agonist-antagonists (Butorphanol, Nalbuphine, pentazocine)
• Naltrexone
• Samidorphan
• St. John's wort
• Azole antifungals (such as itraconazole)
• Macrolide antibiotics (such as Erythromycin)
• Seizure medications (such as Carbamazepine)
• Other opioids (codeine, hydrocodone)
• Alcohol
• Marijuana (cannabis)
• Sleep or anxiety medications (Alprazolam, Lorazepam, Zolpidem)
• Muscle relaxants (Carisoprodol, Cyclobenzaprine)
• Antihistamines (Cetirizine, diphenhydramine)