Levomethadyl Compared with Methadone: "It is now clear that methadone as well as LAAM can prolong the QT interval, and that instances of TdP have been reported with both agents. Screening to identify patients at risk for unacceptable degrees of QT prolongation ought to be a part of agonist treatment with any agent known to be a torsadogen. With proper screening and ECG monitoring it seems likely that arrhythmias associated with agonist therapy can be reduced substantially or prevented.
Levomethadyl (LAAM) No Longer Available For Clinical Use
Levomethadyl Compared with Methadone: "Other potential advantages of levomethadyl’s longer duration of action include reduced dispensing time and less opportunity for illegal diversion. Similar to methadone, it suppresses symptoms of withdrawal and produces cross-tolerance. Adverse effects of levomethadyl are infrequent and, when they occur, are the same as those for methadone. The average daily dose is 75 to 115 mg given 3 times per week. Treatment centers that are not open 7 d/wk dispense a larger dosage of levomethadyl before the 48-hour weekend period."
"Facilities were asked how many clients in treatment on March 31, 2016, received medication-assisted opioid therapy drugs for detoxification or maintenance purposes. MAT includes the use of methadone and buprenorphine for the treatment of opioid addiction or dependence, and the use of extended-release injectable naltrexone (Vivitrol®) for relapse prevention in opioid addiction. Methadone is available only at OTP facilities that are certified by SAMHSA’s Center for Substance Abuse Treatment.
"Levomethadyl is a synthetic µ-opioid receptor agonist that is commercially available in a liquid suspension. It is rapidly absorbed from the gastrointestinal tract, although its oral bioavailability is somewhat lower than that of methadone.87 Because of these properties, the opioid effect of levomethadyl is somewhat slower in onset than that of methadone (90 minutes), but it has a much longer duration of action (48-72 hours) and is therefore able to be dispensed 3 times per week."
Methadone Maintenance as a Treatment for Opioid Dependence: "Methadone is a long-acting µ-opioid receptor agonist, introduced in the 1960s, after being developed in Germany at the end of World War II.60 It has an onset of action within 30 minutes61-63 and an average duration of action of 24 to 36 hours. Its oral bioavailability is excellent and approaches 90%.
"The large contribution to mortality from oxycodone and methadone may be because of the long duration of action of methadone and OxyContin. Drug users may accidentally overdose by overlapping doses when the desired euphoric or analgesic effect is slow in coming. Abusers have learned to ingest and inject pulverized OxyContin pills, defeating the controlled-release mechanism and releasing dangerous amounts of the drug within a short time."
"Three primary scenarios characterize current reports of methadone-associated mortality:
- "In the context of legitimate patient care, methadone accumulates to harmful serum levels during the first few days of treatment for addiction or pain (that is, the induction period before methadone steady state is achieved or tolerance develops).
- "Illicitly obtained methadone is used by some individuals who have diminished or no tolerance to opioids and who may use excessive and/or repetitive doses in an attempt to achieve euphoric effects.