In a Sweat Over Methadone

We have talked about this topic before, but I came across an interesting post by a physician who specializes in addiction medicine who seems to have a real good grasp on Opiate Replacement Therapy (ORT) so I wanted to share it with you guys.



In a Sweat Over Methadone


We’re nearing the end of a particularly hot summer, and patients have often asked about “sweating out” their methadone dose. They describe opioid withdrawal symptoms, and many ask if methadone is excreted in sweat.

Is methadone excreted in sweat? Yes, it is, but in very small amounts. We know this from sweat testing, a newer type of drug testing. With a sweat test, a patch is applied to the skin and left in place for varying lengths of time varying from12 hours to one week. Even with the one-week patches, the amount of methadone excreted is measured in nanograms. As a frame of reference, it takes one million nanograms to equal one milligram. In other words, sweat contains methadone in miniscule amounts, and not enough to drop the blood level of a patient maintained on methadone.

However, when people sweat, it often indicates they are being more physically active than usual, or are exerting themselves in a hotter environment. This increase in metabolism can speed the metabolism of methadone. So even though tiny amounts of methadone are found in sweat, the sweating serves as a marker of higher metabolism, which may reduce blood levels of methadone.

To further complicate things, methadone makes people sweat more, sometimes with little or no activity. All opioids can do this, but methadone seems to be particularly bad about causing sweating. Most patients don’t become tolerant to this annoying side effect, but there are ways to manage the sweating (see my blog entry from 12/29/10).

Methadone and its metabolites are primary excreted by the kidneys, but also are excreted by the bowels. Methadone is excreted in breast milk, but not in significant amounts, as well as semen. (1) Methadone and its metabolites can be found in saliva, thus the usefulness of oral swab drug testing.

original link

http://janaburson.wordpress.com/2011/08/20/in-a-sweat-over-methadone/





Here is a copy of the blog entry she was talking about that she posted on 12/29/10

Methadone and Suboxone Can Cause Sweating

All opioids can cause sweating and flushing. But methadone is perhaps worse than the other opioids, since we use doses high enough to block opioid receptors, to get the maximum benefit from methadone in the treatment of opioid addiction. Buprenorphine (active ingredient in the brand Suboxone and Subutex) can also cause sweating, but since it’s a weaker opioid, people don’t seem to be as badly affected by it.

We don’t know exactly why opioids make people sweat, but it is related to opioids’ effects on the thermoregulatory centers of the brain.

Excess sweating can also be caused by opioid withdrawal. If other withdrawal symptoms are present, like runny nose, muscle aches, or nausea, an increase of the methadone dose may help reduce the sweating.

At least half of all patients on methadone report unpleasant sweating, but some patients have sweats that are more than just inconvenient. These patients report dramatic, soaking sweats, bad enough to interfere with life.

First, non-medication methods can be attempted. These methods include common sense things like wearing loose clothing, keeping the house cool, and losing weight. Regular exercise helps some people. Talcum powder, sprinkled on the areas that sweat, can help absorb some of the moisture. Antiperspirants can be used in the underarm area, but also in any area that routinely becomes sweaty. The antiperspirant can be applied at bedtime so sweating won’t interrupt sleep. There are prescription antiperspirants, like Drysol or Xerac, but these sometimes can be irritating to the skin. Avoid spicy foods, which can also cause sweating.

Make sure the sweating isn’t coming from any other source, like an overactive thyroid, and check your body temperature a few times, to make sure you don’t have a fever, indicating the sweating could be from a smoldering infection. A trip to the primary care doctor should include some basic blood tests to rule out medical causes of sweating, other than the dose of methadone.

Some prescription medications can help, to varying degree, with sweating.

Clonidine, a blood pressure medication that blocks activation of part of the central nervous system, blocks sweats in some patients.

Anticholenergic medicines, drugs block the effect of the neurotransmitter acetylcholine in the involuntary nervous system, block sweating. Anticholinergics tend to dry all secretions, causing such common side effects as dry mouth and dry eyes. These medications can cause serious side effects, so they must be prescribed by a doctor familiar with the patient’s medical history.

Some examples of anticholinergics include oxybutynin (also used for urinary leakage), bipereden (used in some Parkinson patients), scopolamine (also used for sea sickness), and dicyclomine (used for irritable bowel syndrome). All of these have been used for excessive sweating with various degrees of success, in some patients.

For unusually bad situations, Botox can be injected under the skin of the most affected areas, like armpits, palms and soles. Obviously, this is somewhat of a last-resort measure.

Patients affected with severe sweats, unresponsive to any of the above measures, need to decide if the benefit they get from methadone outweighs the annoyance of the side effects. In other words, if being on methadone has kept them from active drug addiction, which is a potentially fatal illness, it would probably be worth putting up with sweating, even if it’s severe.

original link

http://janaburson.wordpress.com/2010/12/29/methadone-and-suboxone-can-cause-sweating/