Which of the following is a precaution when prescribing methadone?

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Methadone carries a real risk of respiratory depression and can affect intracranial pressure, so it’s essential to consider conditions that lessen a patient’s ability to compensate. In individuals with severe asthma or chronic respiratory disease, the respiratory system has limited reserve, and methadone can blunt breathing further, leading to dangerous hypoxia. Similarly, a history of head injury raises concern because sedation and reduced ventilation from methadone can increase carbon dioxide levels, potentially raising intracranial pressure and worsening brain injury. For these reasons, this medication should be avoided or used with extreme caution in such patients. It’s worth noting that methadone is not contraindicated in pregnancy and is not a non-addictive analgesic, reflecting its complex risk profile and the need for careful monitoring rather than blanket avoidance. In practice, assess respiratory status and brain injury history, monitor closely, and consider alternatives or enhanced supervision when these precautions are present.