Alterations in Methadone Metabolism During Late Pregnancy

Traditionally, methadone maintenance therapy has been a once-daily dosing schedule. The current study evaluates the effectiveness of this regimen during pregnancy. A total of 23 pregnant and 16 non-pregnant opioid-dependent patients were studied in two phases to evaluate pregnancy-dependent changes in methadone pharmacokinetics. In the first phase, pregnant patients had a statistically significant higher elimination rate constant (k) and lower half-life compared to non-pregnant controls. In the second phase, the apparent clearance (Cl/F) was significantly greater during pregnancy, with preliminary data suggesting that this observation results from a decrease in the fraction of dose absorbed (F). The implications of these findings on dosing regimens during pregnancy is discussed.