Types of compounds available aqueous solution

Pharmacokinetics: onset of opioid effect is 2 to 4 h; duration of action is 48 to 72 h; half-lives for LAAM and its metabolites are 2 to 4 days; it takes 2 weeks to reach steady state.

Side-effects: too rapid escalation of the dose may result in sedation, orthostatic hypotension, poor concentration, and overdose.

Toxic effects: as for methadone. Overdose occurs with too frequent (daily) dosing, use of multiple drugs, or 'on-top' use due to impatience with its slow onset of action.

Indications: maintenance, stabilization, and detoxification (where supervised consumption is available), or if methadone does not stop withdrawal symptoms for the full 24 h.

Contraindications: pregnancy (transfer to methadone). Dose should be reduced in elderly people, and in renal and hepatic impairment. Interactions: as for methadone.

Effects of withdrawal: as for methadone, but with a milder withdrawal syndrome.

Dosage and administration: give three times a week or on alternate days. Increase dose by 20 to 40 per cent prior to 72-h dosing interval. Transfer methadone to LAAM by giving 1.2 to 1.3 times the daily methadone dose; and LAAM to methadone by waiting at least 48 h and then giving 0.8 times the LAAM dose. If low or unknown tolerance, the initial dose is 20 to 40 mg three times weekly. Adjust dose in 5- to 10-mg steps, but no more frequently than weekly at the most. Strongly warn patients of the risk of supplementation with street drugs especially prior to steady state. LAAM is detected by urine screens for methadone, and close clinical and urine monitoring is necessary to assess compliance and on-top use.

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