Altice FL, Cooney E, Friedland GH; Conference on Retroviruses and Opportunistic Infections.
Program Abstr 6th Conf Retrovir Oppor Infect Conf Retrovir Oppor Infect 6th 1999 Chic Ill. 1999 Jan 31-Feb 4; 6th: 137 (abstract no. 372).
Yale University AIDS Program, New Haven, CT.
Objective: To describe NVP-induced methadone withdrawal in HIV-infected patients. Methods: Retrospective chart review from an urban HIV clinic. Methadone levels were determined by gas chromatography. Results: Seven cases of methadone-maintained patients (mean dose = 76mg/D, range = 30-115 mg/D) developed symptoms of opiate withdrawal within 4-8 days after initiation of NVP therapy. Cases had a mean CD4 = 319, log HIV-1 RNA = 4.22 and one was antiretroviral (ART) naive. The trough methadone levels, determined at the time of withdrawal symptoms for 3 patients, were extremely low (0.06-0.17mcg/mL). Methadone levels were therapeutic before NVP initiation for two of these three patients who were tested. Methadone dosing was increased to > 150 mg/D in all three cases who remained on NVP; it was also increased unsuccessfully for 3 others. Four patients discontinued NVP and one declined any further ART. Conclusions: NVP, a potent inducer of CYP3A4, may induce metabolism of methadone and clinically precipitate opiate withdrawal in patients receiving both medications. These results have important implications for HIV therapeutics in opiate-addicted persons and emphasize the need to perform drug interaction studies in this population. Such studies may guide escalation of methadone dosing when such drug interactions are anticipated.
Publication Types:
Keywords:
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- Antiretroviral Therapy, Highly Active
- Drug Interactions
- Drug Therapy, Combination
- HIV Infections
- HIV Seropositivity
- Humans
- Methadone
- Narcotics
- Nevirapine
- Substance Withdrawal Syndrome
- drug therapy
- therapy
Other ID:
UI: 102189028
From Meeting Abstracts