Methadone vs. Fentanyl for Pain: Important Differences and Potential Risks.

Key takeaways

Methadone (Methadose, Methadone HCl Intensol) and fentanyl (formerly branded as Duragesic) are both opioids used to manage severe pain, but they have some key differences. Methadone is available in oral forms like tablets and liquids, while fentanyl is used as a transdermal patch. Methadone is also used to treat opioid use disorder (OUD) and requires supervision at a methadone clinic initially, whereas fentanyl is only for those already taking opioids around-the-clock. Methadone can be habit-forming and has a risk of life-threatening slow breathing, similar to fentanyl, which also carries risks of addiction, misuse, and overdose. Fentanyl patches need to be changed every 72 hours and can be worn while showering, but exposure to heat can increase the risk of overdose. Both medications have serious side effects, including the potential for life-threatening breathing problems and withdrawal symptoms in newborns if used during pregnancy.

Methadone

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fentanyl patch

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Summary for Methadone

Prescription only

Methadone is an opioid medication. It's used to treat adults with long-term pain that's not relieved by non-opioid pain medications. Methadone is also used with counseling and support programs for opioid use disorder (or opioid addiction). When it's used for opioid use disorder, it's first given at a methadone clinic under the supervision of a healthcare professional (HCP). Methadone is available as tablets, liquids, and dissolvable tablets that are taken by mouth. It's common to have side effects like lightheadedness, dizziness, and sleepiness.

Indications for Methadone

Long-term pain that isn't relieved by non-opioid pain medications alone - except for Methadose brand name and its generics)
Treatment and maintenance of opioid use disorder (OUD) - all brand names and generics

Pros and Cons for Methadone

Pros

Comes as a tablet and liquid that are taken by mouth
Available as a lower-cost generic version

Cons

Can cause life-threatening slow breathing, especially if it's mixed with alcohol
Has potential to be habit-forming

Common Side Effects for Methadone

Lightheadedness
Dizziness
Sleepiness
Nausea
Vomiting
Sweating

Warnings for Methadone

Potential for misuse and addiction
Dangerously slow breathing (respiratory depression)
Risk for opioid overdose
Difficulty concentrating and extreme sleepiness
Life-threatening heart rhythm problems (QT prolongation)
Drug interactions
Harm to newborn babies
Serotonin syndrome
Low blood pressure
Low adrenal hormone levels
Seizures
Low blood sugar (hypoglycemia)
Withdrawal symptoms

Summary for Fentanyl

Prescription only

The fentanyl transdermal patch, previously known by the brand name Duragesic, is an opioid. It's a patch that's applied on the skin every 3 days to manage severe, long-term or chronic pain. The fentanyl patch is only approved for people who are "opioid tolerant" whose pain isn't controlled well enough with other treatment options. Fentanyl is a very powerful opioid, so the medication can be especially dangerous for those who aren't opioid tolerant because of their high risk for extremely slowed breathing and overdose. Some side effects include nausea, vomiting, and sleepiness.

Indications for Fentanyl

Severe, chronic pain in people who are opioid tolerant

Pros and Cons for Fentanyl

Pros

A possible option for severe, chronic pain if you've already tried other treatments and they don't work well enough for you
A possible choice if you have trouble swallowing pills
Replaced on the skin every 3 days

Cons

Only approved for people who are already taking opioids around-the-clock (opioid tolerant)
High risk for dangerously slow breathing, misuse, and addiction
Not intended to use as needed, for short-term pain, or for mild pain

Common Side Effects for Fentanyl

Nausea (41%)
Vomiting (26%)
Sleepiness (19%)
Dizziness (10%)
Trouble sleeping (10%)
Constipation (9%)
A lot of sweating (6%)
Tiredness (6%)
Feeling cold (6%)

Warnings for Fentanyl

Potential for misuse and addiction
Life-threatening slowed breathing (respiratory depression)
Risk for opioid overdose
Life-threatening risks with accidental exposure
Life-threatening risks with patch exposure to high temperatures (e.g., heat, high fever)
Difficulty concentrating and extreme sleepiness
Physical dependence and withdrawal
Harm to newborn babies
Drug interactions
Serotonin syndrome
Low blood pressure and slow heart rate
Low adrenal hormone levels
Seizures