Split Dosing Methadone - Does It Really Work

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emily Says:
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I am currently on a hundred and 80 milligrams of methadone and at 8 p.m. every night I start to feel icky and in little withdrawal by morning I am in full withdrawal! if I split my doses and take 90mgs in the morning and 90mgs in the late afternoon will that help my wds? also the main question is when I go to 90 milligrams in the morning will l get sick from only taking the 90 mgs instead of the 180mg? I've been at 180 for a year now and every morning wake up sick. I just really need some help because I am really getting confused and tempted to just get back on opiates and I really don't want to if anybody is educated on this or has experience please help me. l have a really good life now and I really don't want to resort back to that.



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Verwon Says:

Hello, Emily! How are you?

Some people do have this problem, you may need a higher dose of the Methadone overall to last for the whole day, or you could ask them about splitting the dose. Usually they don't, because it is easier to monitor and make sure that someone takes one dose and they can't provide the same monitoring for multiple daily doses.

And whether or not your body adjusts fast, or you get sick form withdrawals will really depend on your body, so there's no way anyone else can answer that.

The FDA classifies this medication as an opiate, so it has the potential to be habit forming and may cause side effects, such as nausea, dizziness, drowsiness, dry mouth and constipation.

Have you discussed it with your care provider? They should be able to help you.

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Elizabeth Says:
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I was about a month into my Methadone Maintenance Treatment when I got pregnant with my youngest child. Because pregnancy more then doubles your metabolism I was sick as a dog the moment my methadone wore off. The doctor at my clinic started requiring a split dose for me, I was at 160 MG so I took 80 in the morning and 80 at night. It took a little while to get used to having less medicine in the morning but once I did I started to feel better. I have "take homes" & I still split my dose most days. When I don't split my dose I feel sick and don't sleep well at night. I have pretty fast metabolism so the split seems to work for me. If you're worried about feeling unwell in the a.m. having less methadone, try splitting your dose so that you take maybe 70% in the a.m. and 30% at night rather then 50/50. Best of luck to you...

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Aim Says:
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Hi I'm currently prescribed Topamax 4 bipolar Lexapro for depression Klonopin for anxiety 1 mg at bedtime and 140 mg of methadone daily question is those psychotic meds going to interfere with the Methadone effects and purpose?

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Elizabeth Says:
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In response to Emily - Hi there! My name is Liz and I have a very similar experience to share. I too suffered from severe withdrawal symptoms at night after my methadone wore off and could not even get through an entire night's sleep without waking up very ill. Splitting my dose was the best thing I ever did with this medicine. I'm at 95 Miligrams and I have take-homes so I'm able to take 1/2 of my dose in the morning and 1/2 in the evening. I used to be at a much higher dose (160 MG) and I've been splitting my dose for years - anyone with high metabolism, such as myself, will benefit from split - dosing. I understand your concerns about feeling sick from only taking 1/2 your dose at a time but chances are if you're a long-term maintenance patient and your medicine does not last, (sounds like you also have a rapid metabolism??) I strongly recommend that you try the split - what I did to get my body used to not having my whole dose at once is that I started the split unevenly. For example when I wake up, I'd take about 70% of my dose and through the course of a few weeks I was able to split my dose evenly with no withdrawal symptoms. If you have take-homes you can adjust your dose however you need to until you find what works. Some mornings I take my whole dose, other mornings that I feel ok I'll just take a small amount and save most of it for the latter part of my day. If you can just hang in there while you're finding the best way to split your dose you'll be so happy once you find that balance. Don't go back to Opiates sweetie, there's just no way back and all those wonderful things in your life will slowly start to disappear until there's nothing but darkness. Please give the split-dose a chance, be patient with the process because I truly believe that it will work for you. I too felt hopeless, like I was destined to either be an addict or miserably sick everyday on Methadone. Once I found a split-dose formula that worked for me I feel so much better, and I no longer feel hopeless or have any urge to go back to using Opiates. Best of luck to you sweet Emily - please don't give up until you try splitting your dose...Sending you love & support!!

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Katie Says:
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Hey I'm also on methadone and recently they split my dose overall I take 160mgs split so I take 80 mgs in a.m and 80mgs in the afternoon.. I do not like taking such a low dose in a.m it feels like its no working as well and I have to take my p.m dose alot sooner.. But everyone's tolerance and metabolism is completely different.. Try taking a larger amount the split the rest in two halves that way you get 3 doses.. Good luck

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chrissy Says:
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Have you ever considered switching to suboxone? I took methadone for addiction for over 3 years & slowly took down my dose, I didn't want to have to travel to the clinic at least once a week for the rest of my life, & all the money I put out was ridiculous. When I quit going to the clinic I was sick for over a month, withdraw was still horrible! I started seeing a wonderful doctor who put me on suboxone, which was covered by my insurance 100% (most insurance policies cover it from what I hear). I felt normal for the first time in ten years, not high but not sick. my energy level was far higher then when I was on opiates or methadone. I was so scared that I would still be achy & tired from all the damage I had done to my body while on drugs for so many years. I am so glad I listened to my doctor & didn't go back on methadone, it was the best decision I ever made, I am a better wife & mother for it, & actually have hope to one day be completely off all medications.

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CL Says:

I know you meant well, but if the woman is concerned about 180 mg's of methadone not holding her, I would say the LAST thing she needs to consider at the moment is getting on Suboxone, as the chances of even the highest dose of suboxone holding her is slim to none (180mgs is a HIGH dose, regardless of what anyone says).

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Nicole Says:
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Agree with you 100%- the girl didn't ask anything about Suboxone!

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9
Shelby Says:
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Hi if you get take homes you can split the dose just don't let them know it's your right to do that and if I was you that's what I would do! You should take 2/3 of it in the morning and 1/3 of it at like 3pm I would try that first that's what I would do if I was you

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Kenny Says:
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Hi Emily. I am going thru the same situation only my dose is currently 165. It's always worth a try to split it. If you get take-home dose maybe try it next time? I am not a doctor and I wouldn't want you to have any negative effects so this would be at your own risk. I know what you're thinking,have I done it? No,I'm scared to death,we both know how it feels when we wake up I'd hate to have to deal with that for a whole day. I'm thinking of asking about it tho and doing it on the up and up. I'll post when I do. Good luck.

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11
nick Says:

i've been on methadone 29 years and went from 140 to 180 to 140 currently. this is just my opinion but fast metabolism or not, with methadones half life, i don't believe people go through real withdrawels in less than 24 hours. after 29 years i can miss 2-3 days and just get very tired. feeling sick

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Kenny Says:
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I know it sounds crazy Nick,what you said is what I was thinking and I'm running into more and more folks,Emily was the straw that broke my camel's back. I am curious,what brand methadone are you taking,and what form is it(if it's liquid is it flavored?). I'm taking a shot in the dark with these questions,whaddya think?

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Dr N K Says:
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I too, like Nick, have been taking methadone for over 25 years daily. Started on 40! Ended up on 150mgs daily about 7 years ago and am now on 135mgs. I've tried every method, of dosing. I have a fast metabolism and as the years have gone on methadone has done less and less to make me feel 'normal'. It used to easily get me through a day - there was a time I used to work all day on nothing and dose when I got home - that way I could tolerate feeling a bit rough because I knew I was coming home to my full dose. Your body changes as you age, and you have ups and downs regardless of taking methadone or any other meds. The problem is that when you're on methadone you blame every bad period on it - then begin messing about to feel 'normal' - by messing about I mean things like, having more one day, less on another and mostly a day without before the next pick-up - well that's just stupid, even I know that, but that insidious drug messes with your head. Try feeling crap when you've got 5 days supply sitting there.

I have also found that reducing now, even by 5ml has a huge psychological effect that manifests physically. For the last 2 years I have suffered serious constipation, have a 'beer' belly (which looks odd on a slim guy) and feel pretty rough most days. This is purely as a result of being on this synthetic opioid for so many years. It is absorbed through the lining of the small GI tract and this eventually leads to malabsorption of the active ingredient. There's no use putting the amount up because my body would simply waste more. After 25 years or more the side effects outweigh the benefits to the point you are in a permanent state of poor health, lethargy, low moods. Now my teeth are going, all at once it appears - I'm 47, there's a lot to do with age here and the time I've been taking this drug for than anything else. Like Nick says though - some days I can go without and hardly notice, even sleep fine. Other times I'm awake all night. Stability plays an important role in your routine, however you take it, and it affects everybody slightly differently than others.

I've split dosed in all ratios, which has 'helped' for a time, but I always come back to single- dosing in a morning. Stability is relative anyway - you can be 'stable' for 6 months at a time before having to adjust, or you can be 'stable' for years. It all depends on a whole lot of other factors like diet, exercise, sleep etc. Not everything that's unhealthy is methadone related - I'd argue that processed foods have done the most damage to my digestive system. To complicate matters I was put on diazepam 15mg daily 7 years ago (this was a period in life that through stress of work and raising kids I had what people used to call 'a nervous meltdown' but they kept me on diazepam, then added anti-depressants which made me worse because my labido vanished for 3 years!! Anyway, today I'm on 135mgs of methadone and 10mg of diazepam - I suffer social anxiety to the point I had to stop working. I can't even plan for tomorrow. I wake up every couple of hours and the days are spent taking my 2 and 1/2 year old daughter to nursery for 4 hours, collecting her, feeding her, putting her to bed for an hour or two while my wife earns the money.

This is my third marriage as well. I had a good career and I believe that the diazepam has a lot to do with me having most of my issues. The worst part of it all - I only took opioids for a few months after leaving the Army; I've been in this rubbish ever since bar the odd relapse due to lack of methadone. Plus I tried coke a few times because amphetamine was my actual drug of choice - one day I could only get opioids and the rest is history. I don't imagine a time I'll ever get off the stuff, because I always need more. The truth is, I know from the past I have felt better on lower doses (80mgs daily) but because it only lasts about 4-8 hours therapeutically I kid myself into needing more - but it never helps, I take an extra 50 at night occasionally and 1 out of 5 times I'll get a boost. They need to address the malabsorption and metabolisms of individuals to work out how much and when you should take - all this guesswork just goes on forever, even when you find your perfect regime - it won't last, I can promise you.

Your body ages and things change - that's not methadone, that's a fact of life. One more point to note - I was a Doctor, AM a doctor (trauma) - but that's never been a problem or a factor - I fractured my pelvis in Kuwait and found that morphine is absolutely lovely. After being medically discharged I wanted something to give me more energy- but when opioids were offered I couldn't say no. 3 months though! They would do this now. Methadone, and any drug with a long half-life is great short-term, but your prospects for detox decrease exponentially for every year you stay on it. 80% psychology and 20% physiology. I'm too old to put up with the pain of withdrawal now - so how does that improve? It doesn't. Can I still detox? Not at home, I'm unreliable, like a beat-up old car. I look fit and young for my years. But I feel old. Good luck to all of you. The only advice I can offer is 'Please do all you can to remember this is a short-term solution if it's going to work' - otherwise you're only kidding yourself.

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Kayleigh Says:
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How can you say that????Everyone's body is Different,,just cause you can go 2'3days with NO Methadone,and not got sick!!!!!;How can you make a statement like that?For you to be on methadone for 29yrs,and make a statemeant like that,that No One truly withdrawals before 24hrs"just cause you can go 2/3days with none &not get sick!!!!!Everyone's BODY is different!!!!Everyone!!!!No two people are the same!!!!One has to wonder,you say 29yrs but obviously have no clue about methadone or the human body....to make statements like that and to be absolutely so wrong in what you are putting out there about methadone!that's how your body feels remember your body you can't tell someone that they don't withdrawals before 24hrs cause you don't lol !!!!!!!For someone that's been there SO LONG I would think you would know enough or at least a little about what you've been putting in your body!anyway wish you well

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Cassandra Says:
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I promise you there are people that start early withdrawl symptoms even before 24hours. Ive been clean for four years started on 185mgs after mulitiple blood tests now on 54mgs. Ive been sick the whole time before 24hrs never missed a day and no other drugs. I split somedays somedays no split. Doesnt make alot of diff but sometimes it helps. Im going down in hopes to get off because i just want to feel better, sleep at night, and not wake up sick every single day of my life.

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Martin Says:
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Methadone is a very effective pain killer, I was on it for serious lower leg injuries, I was also entitled to morphine every hour in hospital but only took it perhaps 4 to 5 times a days when the methadone wore off, especially at night) on leaving hospital I did not have the option of extra morphine unless I jumped through hoops, so to avoid the highs and lows of th effect of taking a whole dose in the morning...I split my dose to morning and 6.00 pm. This lowered my opiate (opioid intake but in the 2 weeks following I had to adjust... but did. Opiates are are product of the natural opium poppy) opioids are synthetic and synthesised due to the German worry of running out of natural opiates in WW2. Many health professionals told me I was doing the right thing by splitting the dose and I myself found it better. I do hope this helps.

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Itha Says:
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It does not say on my bottle of methadone how many milligrams I'm taking, but it says "Methadone HCI 65 split 2" on it. How many milligrams does that mean?

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18
djp Says:

Re: nick (# 11)

You have a right to your opinion, and believe me, I have been in every part of this. I have been able to go longer than 24 hrs between doses and now I sincerely am at a point where I am not able to go longer than 8-12 hours sometimes before I actually feel fullblown physical withdrawals, not just the cravings, which come from craving to feel well again and becomes psychological, too, later. They say the halflife for methadone on average is 24 hours, but most medical websites will report it is anywhere from 12-55 hours. You could be just really lucky to keep up a consistent metabolism. I just went 2 days without a dose and I used to be able to handle that and thought this time I could as well and I thought I was going to die by the 8th hour after my last dose, not just the missed dose!

We have to factor in other medications that may be breaking down our absorption or metabolism or whatever, like I have been detoxing and coming off of valium lately, so for some reason as I came off benzos for the first time in a while, a long while, it has affected my methadone dose and made me feel like it wasn't lasting, even though I was actively lowering my dose of methadone, too, at the same time, trying to get off both at once! My doctors told me not to, but I insisted bc I am pregnant and wanted to do it, bc I got off methadone really fast first pregnancy, as soon as I found out. But I was expecting to be pregnant before, so I was coming down as I got pregnant, but this time I had no idea, so I was further along when I began to figure out my options.

Anyway, the difference between being on a split dose, which they just put me on before, was great. I will always pick that option. I also was lucky to be at a clinic that had multiple options for dosing, and full medicaid (Medi-cal) and insurance coverage for all dosing and clinic fees, so it felt free to be there to me, so it wasn't a big financial hardship. They used the orange wafer discs (40mg) and tablets for those that needed them, and the liquid diabetic dose for those that didn't care. I always prefered the tablets and wafers bc they felt like they lasted longer and helped me with chronic pain, which is an issue.

When I had to transfer recently to a new area, they don't do split dosing here, so they had to wean me back to once a day, and I tried it, but I hate it. I feel like at a certain point I feel yucky and sick and then I am checking the clock for when can I feel normal and better and motivated again. It drains me, but it can also be the valium taper I am on, which I just ended, so, many factors!

If anyone has the choice to split dose, I would go for it. I would take half at the clinic, get my takehomes, and take the split whenever I needed it, ideally before bed, but some days I needed it earlier. That's what is good about it.

The other thing is they switched me to liquid from the tablets so I had to get used to that, which feels different, don't know why. This new place I am at in another State has the cherry liquid crap I hate, and it feels stronger at first, only because I metabolize it quickly, and then it's gone, and I literally feel nothing later, same day.

The worst thing to do is try splitting it on your own and managing it because while people who don't take it don't understand why that is, I always end up accidentally taking an extra split one day and then the day before I go back I am short a split or an entire day, and I can make it, but it makes my dose level plasma concentration or whatever it is, not consistent, which makes it harder to get back to feeling "even" again. If I could take my little bottles and split them exactly at 50/50 and go back and then on the day I have to dose at the clinic, got to split that as well, I would have NO problems. It's when I have been off split back to whole day that is harder!

The best thing about split dosing is that if you still need it, you can take the split right after your morning dose, so you shouldn't be scared to try it. You can ask your doctor to dose you at the clinic for a few days to manage it and force you to dose daily and that takes discipline. I would do that until you are happy with split dosing and then go back to take-homes and do it on your own. This way if you fail, you won't end up missing an entire day or splitting too early, like if I wake up at 1am and toss and turn and feel sick by 4am i am thinking to take my first split, and then by early afternoon, I am taking the rest, when ideally, I would be taking my first by 8-10am and then the split 12 hours later. I used to be able to manage that no problem.

Pregnancy has changed my metabolism, and surely being on other medications and detoxing off them can affect how you feel, bc benzo withdrawal feels VERY SIMILAR to methadone withdrawal at first, so I thought maybe I was making a mistake and thought I detoxed OK off benzos but had a problem with methadone so I went up on dose and then I ended up moving, and the split back to single threw me for a loop and I ended up being so regular at taking them every 12 hours I was 2 days off the first week there. I made a bad choice that I regret and told my family about so they were aware of my troubles and they made me feel worse and I know, the baby shouldnt go through how I feel, but I have no idea if she feels exactly what I feel, but it still isn't what they tell you to do.

So, everyone has a right to their unique dose level and taper or whatever, and split dosing is great.

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K Says:
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Re: Dr N K (# 13)

I think you just have poor health and hygein and blaim it on the methadone. Not tryin to be rude

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K Says:
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Re: Itha (# 17)

I think you just have poor health and hygein and blaim it on the methadone. Not tryin to be rude

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