LEVOMETHADYL (Systemic)?
Some commonly used brand names are:
In the U.S.?
Other commonly used names are LAAM, LAM, levacetylmethadol, levo-alpha-acetylmethadol, levomethadylacetate, and MK790.
? Not commercially available in Canada.
Category
- Opioid (narcotic) abuse therapy adjunct
Description
Levomethadyl (lee-voe-METH-a-dil)belongs to the group of medicines known as narcotic analgesics (nar-KOT-ik an-al-GEE-zicks).It is used as a substitute for illegal narcotics in addiction treatment programs.This medicine is not a cure for addiction. It is used as part of an overallprogram that may include counseling, attending support group meetings, andother treatment recommended by your doctor.
Levomethadyl helps prevent the withdrawal symptoms that may occur whenan addict stops using other narcotics. In detoxification programs, the amountof levomethadyl used is slowly decreased until an addict becomes drug-free.In maintenance programs, it is used on a long-term basis to help narcoticaddicts stay away from street drugs. With long-term use, levomethadyl maydecrease an addict's craving for other narcotics.
Another narcotic, methadone, is also used in detoxification and maintenanceprograms. Methadone begins to work faster than levomethadyl does when treatmentis started, but it has to be taken every day. Levomethadyl starts to workslowly, but it does not have to be taken every day. Therefore, some peoplemay start treatment with methadone and then change over to levomethadyl afterseveral weeks. Other people may receive only one medicine or the other duringthe entire time of treatment. Your doctor and your counselor at the clinicwill decide on the best treatment plan for you.
In the U.S., levomethadyl is available only in government-approved treatmentclinics, in the following dosage form:
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For levomethadyl, thefollowing should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to levomethadyl. Also tell your health care professionalif you are allergic to any other substances, such as foods, preservatives,or dyes.
Pregnancy?Methadone is the best medicine for treating pregnantnarcotic addicts. Although there may be rare exceptions, levomethadyl is notrecommended for use by pregnant women. Breathing problems and withdrawal symptomsare likely to occur in babies born to mothers who use levomethadyl duringpregnancy. Also, although levomethadyl did not cause birth defects, it causedearly deliveries and stillbirths in animal studies. In the U.S., the law requiresthat women who may become pregnant must be given pregnancy tests before levomethadyltreatment is started and once a month during treatment.
Breast-feeding?It is not known whether levomethadyl passes intothe breast milk in amounts that may cause dependence or other side effectsin nursing babies. Breast-feeding mothers who wish to use levomethadyl shoulddiscuss this with their doctor.
Children?In the U.S., the law does not allow levomethadylto be used for treating addicts younger than 18 years of age.
Older adults?Many medicines have not been studied specificallyin older people. Therefore, it may not be known whether they work exactlythe same way they do in younger adults or if they cause different side effectsor problems in older people. There is no specific information comparing useof levomethadyl in the elderly with use in other age groups.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takinglevomethadyl, it is especially important that your health care professionalknow if you are taking any of the following:
- Alcohol or
- Barbiturates or
- Carbamazepine (e.g., Tegretol) or
- Chloramphenicol (e.g., Chloromycetin) or
- Cimetidine (e.g., Tagamet) or
- Corticosteroids (cortisone-like medicines) or
- Diltiazem (e.g., Cardizem) or
- Disulfiram (e.g., Antabuse) or
- Divalproex (e.g., Depakote) or
- Erythromycins (medicine for infection) or
- Griseofulvin (e.g., Fulvicin) or
- Isoniazid (e.g., INH, Nydrazid) or
- Oral contraceptives (birth control pills) containing estrogen or
- Phenylbutazone (e.g., Butazolidin) or
- Phenytoin (e.g., Dilantin) or
- Primidone (e.g., Mysoline) or
- Quinine (e.g., Quinamm) or
- Rifampin (e.g., Rifadin)
- Ranitidine (e.g., Zantac) or
- Valproic acid (e.g., Depakene) or
- Verapamil (e.g., Calan)?These medicines may change the waylevomethadyl works in your body. Some of them may cause levomethadyl to startworking more quickly, but to keep working for a shorter time, than usual.Others may cause levomethadyl to start working more slowly, but to keep workingfor a longer time, than usual
- Buprenorphine (e.g., Buprenex) or
- Butorphanol or (e.g., Stadol) or
- Dezocine (e.g., Dalgan) or
- Nalbuphine (e.g., Nubain) or
- Pentazocine (e.g., Talwin)?Like levomethadyl, these medicinesare narcotics. However, they may cause withdrawal symptoms if they are takenduring levomethadyl treatment
- Central nervous system (CNS) depressants (medicine that causes drowsiness)or
- Other narcotics or
- Tricyclic antidepressants (medicine for depression)?The chanceof serious side effects is increased; deaths have occurred when people continuedto use CNS depressant ``street'' drugs, including other narcotics, while takinglevomethadyl
- Naltrexone (e.g., ReVia)?Naltrexone blocks the effects of levomethadyland will cause withdrawal symptoms if taken during levomethadyl treatment
Other medical problems?The presence of other medicalproblems may affect the use of levomethadyl. Make sure you tell your doctorif you have any other medical problems, especially:
- Asthma, emphysema, or other chronic lung disease, or
- Brain disease or head injury or
- Colitis or
- Crohn's disease or
- Enlarged prostate or problems with urination or
- Gallbladder disease or gallstones or
- Heart disease or
- High blood pressure?Levomethadyl has side effects that couldbe dangerous to people with these conditions
- Kidney disease or
- Liver disease or
- Underactive thyroid?The chance of side effects may be increased
Proper Use of This Medicine
Most patients are given their dose of levomethadyl at the clinic. You maybe able to take some doses of your levomethadyl at home if your health careprofessional feels you are responsible to do that. Most people willhave to go to the clinic 3 times a week.
Dosing?The dose of levomethadyl will be differentfor different patients. The following information includes only the averagedoses of levomethadyl.
- For oral dosage form (oral solution):
- For treating narcotic addiction:
- Adults?The first dose of levomethadyl for patients who havenot started treatment with methadone is between 20 and 40 milligrams (mg).The first dose for patients who have been receiving methadone will be a littlehigher than the amount of methadone that was being taken every day, but notmore than 120 mg. Your doctor will then adjust your dose, depending on whetheryou experience withdrawal symptoms or side effects after the first dose. Morethan one change in the dose may be needed, until the right dose for you hasbeen found.
Most people will receive levomethadyl 3 times a week, either on Monday,Wednesday, and Friday or on Tuesday, Thursday, and Saturday. Some people needa larger dose on Friday or Saturday, so that the medicine will last untilthe next visit. In detoxification programs, the dose of levomethadyl willgradually be decreased until the patient is able to stop taking it. In maintenanceprograms, treatment may be continued as long as needed.
If you miss one treatment in your program, your health care professionalwill have to adjust your treatment schedule and dose; you may need to starta new program with a lower starting dose if you miss more than one treatmentor have been off the treatment for more than one week. - Children?In the U.S., levomethadyl cannot be used for patientsyounger than 18 years of age.
Precautions While Using This Medicine
Taking levomethadylis only part of your treatment. Your doctor and your counselor at the clinicwill make a treatment plan for you to follow. This plan may include seeingyour counselor at the clinic regularly, attending support group meetings,and making changes in your lifestyle that will help you stay away from illegaldrugs. The success of your treatment will depend on howcarefully you follow your treatment plan.
This medicine will add to the effects of alcohol and other CNS depressants(medicines that slow down the nervous system, possibly causing drowsiness).Some examples of CNS depressants are antihistamines or medicine for hay fever,other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;prescription pain medicine or other narcotics; barbiturates; medicine forseizures; muscle relaxants; or anesthetics, including some dental anesthetics. It is very important that you do not drink alcoholicbeverages or take any CNS depressants during levomethadyl treatment unlessyou have been directed to do so by a doctor who knows that you are takinglevomethadyl. Even if you continue to have some withdrawal symptomsand to crave narcotics for a while after levomethadyl treatment has been started, do not use illegal narcotics or other CNS depressant``street'' drugs. Taking ``street'' drugs together with levomethadyl has causedsome people to die from an overdose.
Levomethadyl may cause some people to become drowsy, especially when treatmentis started or the dose is increased. Make sure you knowhow you react to this medicine before you drive, use machines, or do anythingelse that could be dangerous if you are drowsy or are not alert and clearheaded. This effect usually goes away after a few days, when your body getsused to the medicine. However, tell your counselor atyour next visit to the clinic if any dose causes drowsiness that is severeenough to interfere with your activities.
Dizziness, lightheadedness, or even fainting may occur when you get upsuddenly from a lying or sitting position. Getting upslowly may help lessen this problem. Also, lying down for a while mayrelieve dizziness or lightheadedness.
Tell all health care professionals you go to that youare taking levomethadyl. This is especially important if any kind ofsurgery or emergency treatment is needed. Serious side effects can occur ifyour health care professional gives you certain other medicines without knowingthat you are taking levomethadyl.
Using narcotics such as levomethadyl for a long time can cause severe constipation.To prevent this, your counselor may direct you to take laxatives, drink alot of fluids, or increase the amount of fiber in your diet. Be sure to followthe directions carefully, because continuing constipation can lead to moreserious problems.
Levomethadyl may cause dryness of the mouth. For temporary relief, usesugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute.However, if dry mouth continues for more than 2 weeks, check with your dentist.Continuing dryness of the mouth may increase the chance of dental disease,including tooth decay, gum disease, and fungus infections.
For women only:
- Although there may be rare exceptions, levomethadylis not recommended for use by pregnant women. Pregnancy tests willbe given once a month during treatment. If you miss anyof these tests you may not be able to continue receiving levomethadyl.
- Women who may become pregnant should use effectivebirth control during levomethadyl treatment. If you are not sure whatmethod of birth control will work best for you, check with your counselorat the clinic.
- If you plan to become pregnant, you should first discuss your planswith your doctor or your counselor. They can arrange for you to receive methadoneinstead of levomethadyl.
- If you think you have become pregnant during treatment, tell your counselor right away.
Some people may be transferred to methadone after receiving levomethadylfor a while. If you are given any take-home doses of methadone, do not take the first dose of methadone for at least 48 hours (2 days) afteryour last dose of levomethadyl. Taking the 2 medicines too close togethermay cause an overdose.
If you think you may have taken an overdose of narcotics,get emergency help right away. Taking an overdose of narcotics, ortaking alcohol or CNS depressants with narcotics, may lead to unconsciousnessor death. Signs of overdose include convulsions (seizures); confusion; severedizziness, drowsiness, nervousness, restlessness, or weakness; and very slowor troubled breathing. It is very important that theemergency room doctor knows that you are physically dependent on a narcoticcalled levomethadyl, that using naloxone to treat your overdose is very likelyto cause withdrawal symptoms, and that you will need to be watched for a longtime because levomethadyl's effects last for several days. However,you may not be able to give this information to the doctor yourself. Therefore, you should direct friends and family members to givethis information to the doctor, if necessary.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.
Get emergency help immediately if any of the following side effects occur:
Signs and symptoms of overdose
Cold, clammy skin; confusion; convulsions (seizures); dizziness (severe); drowsiness (severe); low blood pressure; nervousness or restlessness (severe); pinpoint pupils of eyes; slow heartbeat; slow or troubled breathing; weakness (severe)
Also, tell your counselor at the clinic assoon as possible if any of the following side effects occur:
At each visit to the clinic, be sure to tellyour counselor if any of the following side effects occurred after your lastdose of levomethadyl:
Signs of too much levomethadyl
Signs of not enough levomethadyl (withdrawal symptoms)
Body aches, diarrhea; fast heartbeat; gooseflesh; increasedsweating; loss of appetite; nausea or vomiting; nervousness, restlessness, orirritability; runny nose; shivering or trembling; sneezing; stomach cramps; trouble in sleeping; unexplained fever; unusually large pupilsof eyes; weakness; yawning
The withdrawal side effects listed abovemay also occur after levomethadyl treatment has been stopped or during a changeoverfrom levomethadyl to methadone. Always check with yourcounselor at the clinic if withdrawal side effects occur after you stop takinglevomethadyl.
Other sideeffects may occur that usually do not need medical attention. These side effectsmay go away during treatment as your body adjusts to the medicine. However,check with your counselor at the clinic if any of the following side effectscontinue or are bothersome:
Less common or rare
Anxiety; back pain; blurred vision; chills; coughing; decreased desire for sex; dizziness, lightheadedness, or feeling faint when rising froma lying or sitting position; drowsiness; dry mouth; false sense of well-being; flu-like symptoms; headache; hot flashes; muscle pain; unusual dreams; wateryeyes
Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your doctor.
Developed: 08/11/95
Revised: 08/06/2001
