Severe Hypoglycemia Associated With High-Dose Methadone in a Patient With ESRD: A Case Report and Review.

Methadone is a synthetic opioid widely used in addiction medicine and pain management. Although effective, high-dose methadone has been associated with rare but clinically significant hypoglycemia. This case report describes a 49-year-old man with end-stage renal disease (ESRD) on hemodialysis who developed severe hypoglycemia while receiving high-dose methadone. Laboratory evaluation was consistent with endogenous hyperinsulinemia. Upon dose reduction, hypoglycemic episodes resolved without recurrence. This report highlights the need for cautious dosing and routine glucose monitoring in patients receiving moderate to high methadone doses, particularly those with renal impairment or other risk factors.