Methadone (MOUD) | Drug Overview & Clinical Reference
Methadone (MOUD)
Clinical safety rating: safe
Positive evidence of fetus risks but benefits may outweigh risks in some cases
How it works
Mechanism information is still being processed. Check the DailyMed link in the sidebar for the official prescribing information.
Dosing & administration
Dosing varies by indication and patient profile. Always follow your institution's current prescribing guidelines.
Renal impairment
Consult protocols for adjustment.
Liver impairment
Consult protocols for adjustment.
Use during pregnancy
1st trimester
Safe for OUD treatment. Initiate or continue methadone maintenance.
2nd trimester
Safe. Dose increases often needed in T2-T3 due to increased volume of distribution and metabolism.
3rd trimester
Safe. Expect NOWS in neonate — have neonatal team prepared. QTc prolongation monitoring at high doses.
Clinical note
Standard-of-care MOUD for opioid use disorder in pregnancy. Methadone maintenance therapy reduces illicit drug use, stabilizes maternal physiology, and improves prenatal care engagement and fetal outcomes. Longer-established than buprenorphine in pregnancy with extensive outcome data. Requires daily observed dosing at an opioid treatment program (OTP). Associated with more severe and longer NOWS than buprenorphine. Dose changes required throughout pregnancy due to altered pharmacokinetics. Not the same as analgesic methadone use.
Breastfeeding
Caution. Excreted in breast milk; breastfeeding is encouraged unless maternal HIV-positive or active illicit drug use. Benefits of breastfeeding (bonding, NOWS reduction) generally outweigh risks at low-to-moderate doses.
