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PENGENALAN KEPADA

RAWATAN GANTIAN

METHADONE

Dr. Abdul Jamil bin Ahmad

Pakar Perubatan KeluargaKK Guar Cempedak


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FAKTA PERUBATAN

Penagihan dadah adalah

penyakit yang kronik dan

berulang-ulang.


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HARM REDUCTION bermaksud

mengurangkan kemudaratan yang

akan berlaku akibat pengambilandada! seperti"

#angkitan HI$%AID&! Hepatitis ' ( C! )drug *+erd*se) masala perubatan dan psik*,s*sial penglibatan dalam akti+iti #enaya dan anti,

s*sial yang lain-

APA ITU HARM

REDUCTION?


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.- /endidikan kesiatan bersemuka tentangpenyakit serta kaeda mengurangkan risik*

#angkitan HI$%AID&! Hepatitis dan penyakitkelamin 0&TD1-

2- 3aunseling berkaitan aspek penagian! psik*l*gi!ker*anian! latian kemairan idup danperubaan tingkalaku-

4- U#ian saringan HI$! &TD dan Tuberkul*sis 0T'1

5- Ra6atan perubatan dan pen#agaan kesiatan

KOMPONEN DLM.

HARM REDUCTION


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7- Ru#ukan yang sesuai untuk tindakan susulan

8- /r*gram /enukaran 9arum dan Alat &untikan0Needle ( &yringe E:;ange /r*gram! N&E/1

- /enggunaan k*nd*m bagi tu#uan seksselamat-

KOMPONEN DLM.

HARM REDUCTION


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TERAPI GANTIAN

METADON Rawatan yang dijalankan dengan

menggunakan metadon sebagai gantian

dadah heroin dan morfin bagi penagih tegar.

erkesan dalam rawatan penagihan heroin

dan morfin kerana berupaya menggantikan

dadah merbahaya dengan men!egah tanda"

tanda withdrawal dan mengurangkanketagihan.


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FAEDAH TERAPI GANTIAN

METADON #eningkatkan kesejahteraan kesihatan dan

kehidupan pengguna.

#engurangkan risiko jangkitan $%&' $epatitis

dan C.

#engurangkan dan berhenti melakukan

jenayah bagi mendapatkan sumber

kewangan untuk membeli dadah. #embolehkan pengguna bekerja seperti

biasa.


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WHAT ISWHAT ISMETHADONEMETHADONE

??


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What is Methadone?

(")dimethylamino*"+'+"diphenyl","

hepatanone hydro!hloride

-yntheti! opoid agonist

sed for past ,/ years for treatment of opiate

addi!ts

A!tions and uses similar to those of morphine


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Sejarah Methadone

Methadone disintesis olehahli kimia German ketikaPerang Dunia ke 2 apabilaUSA dan sekutunyamenyekat bekalan opium.Disebabkan kesukaranberperang tanpa analgesic,pihak German mencipta

beberapa jenis ubat yang


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What is methadone?

Synthetic opioid agonist.

Long plasma half life.

Similar to morphine and other opioids.

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Methadone has three importantfunctions:

Relief of pain for about 6 hours

Suppression of opioid withdrawal and

craving for about ! hours

" mood stabili#ing effect for longerperiods

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Absorption

0ell absorbed orally )gut within !$ minutes%

1ong' although 2ariable plasma half life

Peak plasma !on!entrations a!hie2edafter 3 to 4.5 hours following oraladministration

Taken a+ a +ingle daily do+ebe!ause of itsgood oral bioa2ailability ),( 6 3//7* andlong half life


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&linical 'harmacology 'otent synthetic opioid agonist

Well absorbed orally

Slow onset of action Long plasma half life

(ffects are )ualitatively similar to

morphine and other opioids

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&linical 'harmacology

*at soluble and binds to body tissues

Good oral bioavailability

Long half life > 24 hours

Single daily dose

+ro,en down in the liver - &ytochrome '!$ en#ymesystem

/0 given orally - eliminated unchanged 1nactive metabolites - urine and faeces

Secreted in sweat and saliva

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Metaboli#ation

Mainly the liver metaboli#es methadone.

" very small percentage of individuals

metaboli#e methadone rapidly and they can

e2perience withdrawal even on a relatively

high methadone dose.

Split doses may be necessary for these

individuals.

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Metabolism

Methadone

!demethylation

"ytochrome P#$% en&ymes ! "'P(A#, "'P2)* +"'P2"-

"'P2"- + "'P2D*(lesser

2!ethylidene!,$!dimethyl!(,(!diphenylpyrrolidene

/DDP0


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On+et o( e((e't+ / )inute+

Peak e((e't+ Appro0 hour+

!al( li(e Appro0 12 hour+

Ti)e to rea'h +tabili3ation 4 5/ day+


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#ethadone

8 sual effe!ti2e dose9 :/"3;/ mg

8 Rettig' 1ea2itt

8 :/"


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When an individual is stabili#ed on

methadone3 the administration of asingle ade)uate dose 4usually between

6 to / mg% will suppress withdrawal

and craving for about ! hours without

causing euphoria or sedation 4*arrell et

al.3 /55! Roberts et al.3/555%.

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1ndividuals can therefore function

normally and are able to perform mentaland physical tas,s without impairment.

1n sufficient doses3 methadone 7bloc,s8the euphoric effects of other opioids.

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Efects o MethadoneEfects o Methadone

Analgesia

-edation

>uphoria )oral methadone !auses lesseuphoria than %& heroin*


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Side Efects Ma*or ha3ard+ o( )ethadone are re+piratory

depre++ion and +y+te)i' hypoten+ion.

"e+piratory arre+t6 +ho'k6 'ardia' arre+t6 and death

ha%e o''urred. The )o+t (re7uently ob+er%ed +ide e((e't+ in'lude8

8lightheadedness8 di??iness

8sedation8nausea8 2omiting8sweating8 dry mouth8!onstipation

8sleep disturban!e8 2asodilation

8it!hing8menstrual irregularities8 gynae!omastia8se@ual dysfun!tion)impoten!e*8fluid retention

8weight gainContinue


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SaetySaety

1ong term side effe!ts are few Doesnt !ause damage to major organs or body

systems

B!!urred side effe!ts are less harmful than risksof al!ohol' toba!!o and illi!it opiate use

#ajor ha?ard9 o2erdose $igh at the time of ##= indu!tion and used in

!ombination with other sedati2e drugs #ethadone o2erdose !an be de!epti2e and life

threatening


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#ethadone

8 -elamat ketika mengandung

8Kandall

8 =iada kesan buruk jika digunakan dalam

jangkamasa panjang.


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&ontraindication

Severe hepatic impairment.

9ypersensitivity to methadone.

Any situation where opioids are !ontraindi!ated su!h

as9 patients with respiratory depression )in the

absen!e of resus!itati2e euipment or in unmonitoredsettings*' and in patients with a!ute bron!hial asthma

or hyper!arbia

2


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Side Efects

#ajor ha?ards of methadone are respiratory depression

and systemi! hypotension.

Respiratory arrest' sho!k' !ardia! arrest' and death ha2e

o!!urred. =he most freuently obser2ed side effe!ts in!lude9

8 lightheadedness8di??iness8 sedation8nausea8 2omiting8sweating8 dry mouth8 !onstipation

8 sleep disturban!e82asodilation8 it!hing8menstrual irregularities8 gynae!omastia8se@ual dysfun!tion )impoten!e*8 fluid retention8 weight gain

Continue


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TANDA!TANDA O"ERDO#E

Anak )ata )enge'il 9oya6 pening Jalan terhoyong-hayang6 per'akapan tidak *ela+ :adar perna(a+an )enurun & terhenti :adar ke+edaran )enurun6 )engantuk6 +noring. :adar nadi perlahan Tekanan darah )enurun Mulut berbuih :o)a

"i+iko o%erdo+e lebih tinggi ketika induk+i atau

*ika di'a)pur dengan dadah lain

"a;atan +egera8 I&M Nalo0one


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GE$ALA WITHDRAWAL

OPIATE Irritabitily

"i+au

"e+tle++ne++


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GE$ALA WITHDRAWAL

#ula selepas ("3; jam selepas berhenti

morphine dan heroine.

#eningkat keterukan dalam ; hingga + hari

dan tidak kelihatan selepas 4 hari. Jangkamasa gejala withdrawal metadon

adalah lebih lama )5 hingga ;3 hari*

#etadone withdrawal di rasa lebih teruk dariheroin morphine withdrawal.


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Dr! Interactions

Psy!hotropi! drugs )e.g. ben?odia?epines* in!rease thea!tions of methadone

Al!ohol add to the respiratory depressant effe!ts of

methadone Drugs administered !on!omitantly with methadone should

be e2aluated for intera!tion potential


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TERIMA KA#IH

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