Therapeutic drug monitoring in methadone maintenance: Choosing a matrix

Eric T. Moolchan, Annie Umbricht, David Epstein

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Methadone maintenance is the premier pharmacological treatment for opioid addiction, but it is rarely informed by evidence-based practice guidelines for dosage monitoring and adjustment. Such guidelines are crucial because the pharmacokinetics of methadone vary greatly among patients, and this variation may account for differences in treatment outcome. We review the pharmacokinetics of methadone and factors that may alter it (including drug interactions, disease states, and idiosyncratic differences among patients). Also reviewed are prospects for therapeutic drug monitoring (TDM) of methadone in plasma, urine, sweat, and saliva. Due to its easeq of collection and its presumed representation of the bioavailable free-fraction of methadone, saliva may be a promising matrix. However, saliva methadone concentrations are influenced by salivary pH, and future studies are needed to determine how to control for that. Administrative, medical, and social implications of methadone TDM are briefly discussed.

Original languageEnglish (US)
Pages (from-to)55-73
Number of pages19
JournalJournal of Addictive Diseases
Issue number2
StatePublished - 2001
Externally publishedYes


  • Methadone maintenance
  • Opioid addiction
  • Pharmacokinetics

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health


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