Sleep disturbance
Teeth problems
Reduced libido and sexual dysfunction
Lethargy
Excessive sweating
Constipation

Sleep disturbance

A number of resources are available for patients experiencing sleep problems which include guidance regarding sleep hygiene and simple relaxation techniques. (See Appendix 5).

Patients on methadone appear to be at increased risk of sleep apnoea and the use of hypnotic drugs may therefore paradoxically worsen sleep, by exacerbating sleep apnoea.

Teeth problems

All opioids including methadone reduce the production of saliva while illicit use is associated with poor nutrition and poor dental hygiene. Consequently dental problems are common at entry to MMT.

It is common for patients to blame methadone for their dental problems.

Salivary flow can be increased by chewing. Encourage patients to improve dental hygiene.

Reduced libido and sexual dysfunction

Reduced dose may help but needs to be balanced against the risk of return to heroin use.

Lethargy

Elucidate the cause. The methadone dose may need to be reduced.

Excessive sweating

Try reducing the dose although this may not alleviate the symptoms. Sweating can also be a prominent symptom in withdrawal and so careful history taking and observation of the patient prior to dosing may be necessary to assist in making the distinction.

Constipation

People rarely develop tolerance to the constipating effects of opioids and so patients may experience chronic constipation.

Encourage patients to consume plenty of fruits and vegetables and non alcoholic fluids each day. Top of page