Bomb319
Bluelighter
- Joined
- Nov 26, 2011
- Messages
- 583
I have found that methadone metabolizes quite differently depending on the person, diet, other drugs an numerous other factors. I got tired of always feeling slightly sick and drained of energy each morning, so I spent the past several weeks exploring variations in dosing technique and interval in order to find the method which maximizes my blood levels of the drug, and also remains consistent as possible until the next dose. There's a bit of easy math here, so bear with me. The following information assumes your methadone concentration is 1 mg/mL. Please note that you should NEVER CHANGE YOUR DOSING REGIMEN WITHOUT CONSULTING A DOCTOR. These are simply my own results of experimenting, and the conclusions I arrived at should in theory work regardless of what your actual strength of methadone is. However this is for educational purposes only, as I am merely sharing my conclusions of what works for ME. If you're interested in any of these methods, again I can't stress enough that methadone is an EXTREMELY powerful medication which can be deadly for some with even relatively minor strength and interval changes. You MUST. ASK. YOUR. DOCTOR. BEFORE. ATTEMPTING!
First, we make the dose 100 mg so it's easier to work with and so it also gives a percentage; then we can apply it to my dose afterward. We also assume the half life of methadone is 24 hours as is commonly cited. It won't be exactly that, especially with me but it doesn't matter because it's the proportion we're looking for, not the absolute value. Whichever the method, I ALWAYS am given only 220 ml/mg per day and obviously have to work within that limit. I calculated all doses/blood levels for 8 am/8pm. There are 2 dosing methods commonly considered:
1. Simple daily dose at the same time each day. Using 100mg - take 100 mg at eight am. Since half life is 24 hours, blood levels are 50mg by eight am the next day, or 50% target. Looking at it this way, it's not a surprise I can feel fairly sick sometimes at this amount by this time. It's also the theoretical lowest blood concentration possible with daily dosing. It also explains why I wouldn't be full out rip-roaring sick even though it literally can not be any lower - half of all my mu-opioid receptors are still full. Complete withdrawal when concentrations reach 0% would theoretically not be reached for a full 8 days: 100->50->25->12.5>6.25>3.175>1.825>0.9125>0.45625 by which point it has cleared from a pharmacological standpoint. ie the concentration is too low to achieve any physiological effect. If you take 100 mg et eight am one morning, and the half life is 50%, then naturally you will have 100 - 50 = 50 mg or 50% as much methadone left in your system by eight am the next day (not taking into account any previous methadone lingering in your blood from prior dosages)
2. Split dosing - instead of taking 100mg once a day, we take 50 mg twice. So at eight am, you've got 50. We will need half of the half life in this case, or the quarter life, to find out what blood levels will be at eight PM on the same day rather than the next morning. So a quarter of 50 is 12.5, so 12.5 mg of a 50 mg dose will be metabolized by eight pm - 50 - 12.5 = 37.5 mg, at which point we take out second 50 mg dose which gives us 50 + 37.5 = 87.5 mg. At this point, there are twelve more hours to go until the next day's morning dose, so we take the quarter life of 87.5 which is 21.875. Therefore 87.5 - 21.875 = 65.265 mg or 65.265% by eight am the next day using method 2 and splitting your dose exactly in half at equal intervals.
Now you can see why many doctors advocate split dosing. You'll retain 15.265% more methadone in your blood without increasing your actual dosage whatsoever. Unfortunately with me, since it's not quite as effective as it is for most people, 65 % isn't perfect. It certainly is better, and I definitely notice that increased amount, but the way I figure, there's one more way to do this, and this way works the best for me. I've done it twice now, and I barely feel sick at all by my next dose. Keep in mind I only get 220 per day which I can divvy up as I want. BE WARNED THAT THIS INVOLVES ESSENTIALLY CONSUMING MORE METHADONE IN A GIVEN TIME PERIOD THAN YOU OTHERWISE WOULD WITH THESE OTHER METHODS, SO DO NOT TAKE THIS LIGHTLY, AND ALWAYS CONSULT WITH YOUR DOCTOR FIRST. I absolutely do NOT reccommend trying to do the following if your dose is greater than 100, or if you haven't taken methadone daily for a very long time. You should also make sure never to try this if you are the least bit unsure of your tolerance. You can NOT afford to experiment with your life!!!!
That said, what if I took my full regular dose in the am, plus HALF of my next take home dose in the pm on the same day? I know that initially you'll think that doesn't sound very safe, but I checked with my doctor first, and thoroughly researched it before trying it. In fact if you think about it, it's essential to do this if switching from a daily dosing interval to a split dose because you need to take the next day's half either shortly after your LAST FULL dose, or shortly before your NEXT FULL dose. It's almost the same thing as simply taking your regular full dose later at night, then taking your next one early in the am - the difference being how much methadone is metabolized while you sleep (ie 8 hours difference and negligible in terms of harm). Tolerance from being on the program long term makes it safer, but keep in mind everybody is different, and NOTHING is foolproof.
Now here's the interesting thing: this is the resulting math of this unusual dosing pattern: take 100 mg at eight am, and you have roughly 75 mg left in your blood by eight pm (quarter life again subtracted from 100). Now you're adding another 50 mg to this at eight PM resulting in a blood level of 75 + 50 = 125 mg. Then you take your second 50 mg dose - the quarter life of this total will give you your blood levels by eight am the next morning, keeping it consistent with the other two methods in terms of your total daily allocated dose. So the quarter life of 125 is: 125 - 31.25 = 93.75 mg, or 93.75% by eight am the next day using this method! Obviously this is the most ideal of all methods, since you have nearly the same amount in your blood by the time of your next dose as you did for the previous day shortly after taking your regular dose. It's also healthier to avoid dramatic fluctuations of methadone in your blood, so this works on multiple levels. I can honestly tell you that I have experimented with this method and found it to be very successful. Whenever I noticeably increase my one or two-time dose, I feel noticeably better (or even buzzed) for much longer - even without taking any methadone at all the next day to compensate (you obviously can't do this any more frequently than every other day since that would require more methadone than what you are currently prescribed). It may seem counterintuitive, but due to it's long half life, it certainly appears that one single higher than usual dose will hold you at least as well and likely better than the same dose divided in intervals will. You can now use these percentages I obtained to observe the rough levels of methadone remaining in your blood by the time of your next dose. Using myself as an example with a 220 mg dose:
Method 1: 50 percent of 220 mg = 110 mg left by eight am.
Method 2: 65.265 percent of 220 mg = 143.583 mg left by eight am.
Method 3: 93.75 percent of 220 mg = 206.25 mg left by eight am.
Now you can obviously see why it works so much better to take more methadone at roughly the same time followed by a longer period of total abstinence, in lieu of consistently taking smaller doses but more often. The effect is real and profound. It can make all the difference in the world for someone who is benefited by methadone but experiences significant disruptions or periods of mild to moderate withdrawal because of their varying metabolisms. The math is all there, and unless I royally fucked something up (which is certainly a possibility given my lack of mathematical proficiency), this seems like a complete solution to my problem. That's why this is very important for me to check with you. I know it's long again, but this time it's a critical decision I need to make and not just rambling on and on
Don't laugh at me, but this actually took me quite awhile to figure out because I did it while out for a walk, and I have a lot of trouble doing math in my head.
Obviously there is one limitation with this method - as I noted briefly above, you can't do it every day, because that would require 1.5 times the amount of your dose of methadone. Since you have to work with the same absolute amount, you cannot take any more methadone for the rest of that day; this still leaves a respectable amount in your blood by night time, but with the additional advantage of not needing it as much as you would during the day while working, since you're just going to be sleeping anyway. Then you can do the same thing the following morning, which ensures your blood levels are ALWAYS going to be normal and consistent throughout each and every working day. It essentially amounts to "one day on, one day off" while shifting the day on up by 1.5x. While there should still be enough left in the blood by the end of the day off such that there shouldn't be a physical problem, the PSYCHOLOGY of waking up and knowing you aren't / can't take any methadone that day is something I will certainly need to overcome, as the psychology of withdrawal is very strong, and placebo plays a large role. I'm finding that these fears are unfounded and purely mental, but to each his or her own.
I'll finish up here by saying once again that I cannot stress strongly enough that methadone is a very powerful drug as you most likely know, and can easily turn out tragically if your limits are pushed. ANY sudden changes - even just by altering your dosing schedule abruptly and not the total amount taken - can be very profound, possibly dangerous and therefore highly unadvisable. I am NOT a doctor, and anyone interested in attempting this should make sure they have researched it inside out, have a good idea of how it would likely apply to and affect them, first discuss it with their doctor or licensed counsellor and above all take NO risks, and if adopting this method, it's far better to change over to this pattern SLOWLY by increasing the initial higher dose by only one or two mg at the beginning as a precaution.
Good luck, and feel free to ask me any questions and I will try to help as best I can. I'm sorry this got so lengthy, but hopefully you guys will find it quite useful if you're anything like me
EDIT: One last note: this does not take into account any other factors present which can infuence how quickly (or slowly) your methadone is metabolized. For example, stomach contents are the single biggest factor in my case. I ALWAYS dose on an empty stomach, because it kicks in after only 40 minutes or so and unquestionably has a much bigger impact. That said, I have no idea if I end up paying for this on the other end. In other words, I may be increasing it's effective potency but at the cost of its longevity.
Of course other drugs have the potential to dramatically affect this as well - particularly potentiatiors such as diphenyhramine. I know most of us on MMT know this already, and these factors don't really alter these proposed dosing methods in any significant way since all regimens would be affected in more or less the same way by these other factors. That said, if you're packing in a greater amount of methadone in a shorter period of time, it's MUCH better to have NO OTHER DRUGS in your system. At the very least, avoid benzodiazepines like the plague unless you know DAMN SURE what you're doing, ie: you're on a very low dose, have a very high opiate tolerance, and it's been approved by your doctor.
I know this is a very long post, so here's a basic summary:
SUMMARY:
Daily Dosing - 50% remains in your blood by next dose
Split Daily Dosing - 65.265% remains in your blood by next dose
Dose and a half one day with NO DOSE the next day - 93.75% remains in your blood by next dose
First, we make the dose 100 mg so it's easier to work with and so it also gives a percentage; then we can apply it to my dose afterward. We also assume the half life of methadone is 24 hours as is commonly cited. It won't be exactly that, especially with me but it doesn't matter because it's the proportion we're looking for, not the absolute value. Whichever the method, I ALWAYS am given only 220 ml/mg per day and obviously have to work within that limit. I calculated all doses/blood levels for 8 am/8pm. There are 2 dosing methods commonly considered:
1. Simple daily dose at the same time each day. Using 100mg - take 100 mg at eight am. Since half life is 24 hours, blood levels are 50mg by eight am the next day, or 50% target. Looking at it this way, it's not a surprise I can feel fairly sick sometimes at this amount by this time. It's also the theoretical lowest blood concentration possible with daily dosing. It also explains why I wouldn't be full out rip-roaring sick even though it literally can not be any lower - half of all my mu-opioid receptors are still full. Complete withdrawal when concentrations reach 0% would theoretically not be reached for a full 8 days: 100->50->25->12.5>6.25>3.175>1.825>0.9125>0.45625 by which point it has cleared from a pharmacological standpoint. ie the concentration is too low to achieve any physiological effect. If you take 100 mg et eight am one morning, and the half life is 50%, then naturally you will have 100 - 50 = 50 mg or 50% as much methadone left in your system by eight am the next day (not taking into account any previous methadone lingering in your blood from prior dosages)
2. Split dosing - instead of taking 100mg once a day, we take 50 mg twice. So at eight am, you've got 50. We will need half of the half life in this case, or the quarter life, to find out what blood levels will be at eight PM on the same day rather than the next morning. So a quarter of 50 is 12.5, so 12.5 mg of a 50 mg dose will be metabolized by eight pm - 50 - 12.5 = 37.5 mg, at which point we take out second 50 mg dose which gives us 50 + 37.5 = 87.5 mg. At this point, there are twelve more hours to go until the next day's morning dose, so we take the quarter life of 87.5 which is 21.875. Therefore 87.5 - 21.875 = 65.265 mg or 65.265% by eight am the next day using method 2 and splitting your dose exactly in half at equal intervals.
Now you can see why many doctors advocate split dosing. You'll retain 15.265% more methadone in your blood without increasing your actual dosage whatsoever. Unfortunately with me, since it's not quite as effective as it is for most people, 65 % isn't perfect. It certainly is better, and I definitely notice that increased amount, but the way I figure, there's one more way to do this, and this way works the best for me. I've done it twice now, and I barely feel sick at all by my next dose. Keep in mind I only get 220 per day which I can divvy up as I want. BE WARNED THAT THIS INVOLVES ESSENTIALLY CONSUMING MORE METHADONE IN A GIVEN TIME PERIOD THAN YOU OTHERWISE WOULD WITH THESE OTHER METHODS, SO DO NOT TAKE THIS LIGHTLY, AND ALWAYS CONSULT WITH YOUR DOCTOR FIRST. I absolutely do NOT reccommend trying to do the following if your dose is greater than 100, or if you haven't taken methadone daily for a very long time. You should also make sure never to try this if you are the least bit unsure of your tolerance. You can NOT afford to experiment with your life!!!!
That said, what if I took my full regular dose in the am, plus HALF of my next take home dose in the pm on the same day? I know that initially you'll think that doesn't sound very safe, but I checked with my doctor first, and thoroughly researched it before trying it. In fact if you think about it, it's essential to do this if switching from a daily dosing interval to a split dose because you need to take the next day's half either shortly after your LAST FULL dose, or shortly before your NEXT FULL dose. It's almost the same thing as simply taking your regular full dose later at night, then taking your next one early in the am - the difference being how much methadone is metabolized while you sleep (ie 8 hours difference and negligible in terms of harm). Tolerance from being on the program long term makes it safer, but keep in mind everybody is different, and NOTHING is foolproof.
Now here's the interesting thing: this is the resulting math of this unusual dosing pattern: take 100 mg at eight am, and you have roughly 75 mg left in your blood by eight pm (quarter life again subtracted from 100). Now you're adding another 50 mg to this at eight PM resulting in a blood level of 75 + 50 = 125 mg. Then you take your second 50 mg dose - the quarter life of this total will give you your blood levels by eight am the next morning, keeping it consistent with the other two methods in terms of your total daily allocated dose. So the quarter life of 125 is: 125 - 31.25 = 93.75 mg, or 93.75% by eight am the next day using this method! Obviously this is the most ideal of all methods, since you have nearly the same amount in your blood by the time of your next dose as you did for the previous day shortly after taking your regular dose. It's also healthier to avoid dramatic fluctuations of methadone in your blood, so this works on multiple levels. I can honestly tell you that I have experimented with this method and found it to be very successful. Whenever I noticeably increase my one or two-time dose, I feel noticeably better (or even buzzed) for much longer - even without taking any methadone at all the next day to compensate (you obviously can't do this any more frequently than every other day since that would require more methadone than what you are currently prescribed). It may seem counterintuitive, but due to it's long half life, it certainly appears that one single higher than usual dose will hold you at least as well and likely better than the same dose divided in intervals will. You can now use these percentages I obtained to observe the rough levels of methadone remaining in your blood by the time of your next dose. Using myself as an example with a 220 mg dose:
Method 1: 50 percent of 220 mg = 110 mg left by eight am.
Method 2: 65.265 percent of 220 mg = 143.583 mg left by eight am.
Method 3: 93.75 percent of 220 mg = 206.25 mg left by eight am.
Now you can obviously see why it works so much better to take more methadone at roughly the same time followed by a longer period of total abstinence, in lieu of consistently taking smaller doses but more often. The effect is real and profound. It can make all the difference in the world for someone who is benefited by methadone but experiences significant disruptions or periods of mild to moderate withdrawal because of their varying metabolisms. The math is all there, and unless I royally fucked something up (which is certainly a possibility given my lack of mathematical proficiency), this seems like a complete solution to my problem. That's why this is very important for me to check with you. I know it's long again, but this time it's a critical decision I need to make and not just rambling on and on
Don't laugh at me, but this actually took me quite awhile to figure out because I did it while out for a walk, and I have a lot of trouble doing math in my head.Obviously there is one limitation with this method - as I noted briefly above, you can't do it every day, because that would require 1.5 times the amount of your dose of methadone. Since you have to work with the same absolute amount, you cannot take any more methadone for the rest of that day; this still leaves a respectable amount in your blood by night time, but with the additional advantage of not needing it as much as you would during the day while working, since you're just going to be sleeping anyway. Then you can do the same thing the following morning, which ensures your blood levels are ALWAYS going to be normal and consistent throughout each and every working day. It essentially amounts to "one day on, one day off" while shifting the day on up by 1.5x. While there should still be enough left in the blood by the end of the day off such that there shouldn't be a physical problem, the PSYCHOLOGY of waking up and knowing you aren't / can't take any methadone that day is something I will certainly need to overcome, as the psychology of withdrawal is very strong, and placebo plays a large role. I'm finding that these fears are unfounded and purely mental, but to each his or her own.
I'll finish up here by saying once again that I cannot stress strongly enough that methadone is a very powerful drug as you most likely know, and can easily turn out tragically if your limits are pushed. ANY sudden changes - even just by altering your dosing schedule abruptly and not the total amount taken - can be very profound, possibly dangerous and therefore highly unadvisable. I am NOT a doctor, and anyone interested in attempting this should make sure they have researched it inside out, have a good idea of how it would likely apply to and affect them, first discuss it with their doctor or licensed counsellor and above all take NO risks, and if adopting this method, it's far better to change over to this pattern SLOWLY by increasing the initial higher dose by only one or two mg at the beginning as a precaution.
Good luck, and feel free to ask me any questions and I will try to help as best I can. I'm sorry this got so lengthy, but hopefully you guys will find it quite useful if you're anything like me
EDIT: One last note: this does not take into account any other factors present which can infuence how quickly (or slowly) your methadone is metabolized. For example, stomach contents are the single biggest factor in my case. I ALWAYS dose on an empty stomach, because it kicks in after only 40 minutes or so and unquestionably has a much bigger impact. That said, I have no idea if I end up paying for this on the other end. In other words, I may be increasing it's effective potency but at the cost of its longevity.
Of course other drugs have the potential to dramatically affect this as well - particularly potentiatiors such as diphenyhramine. I know most of us on MMT know this already, and these factors don't really alter these proposed dosing methods in any significant way since all regimens would be affected in more or less the same way by these other factors. That said, if you're packing in a greater amount of methadone in a shorter period of time, it's MUCH better to have NO OTHER DRUGS in your system. At the very least, avoid benzodiazepines like the plague unless you know DAMN SURE what you're doing, ie: you're on a very low dose, have a very high opiate tolerance, and it's been approved by your doctor.
I know this is a very long post, so here's a basic summary:
SUMMARY:
Daily Dosing - 50% remains in your blood by next dose
Split Daily Dosing - 65.265% remains in your blood by next dose
Dose and a half one day with NO DOSE the next day - 93.75% remains in your blood by next dose
Last edited:
