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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Pharmacokinetic Interactions of Nevirapine and Methadone and Guidelines for use of Nevirapine to Treat Injection Drug Users [Clark SM et al. CID 2001;33:1595] The authors studied the pharmacology of methadone in eight patients who were receiving stable daily methadone maintenance therapy. The results showed a substantial reduction in the mean AUC for methadone from 12,024 ng.h/mL to 5,713 ng.h/mL. There was a 36% reduction in the mean maximum concentration of methadone, and 6 of the 8 participants complained of methadone withdrawal symptoms from days 8-10 onward.
Comment: Previous studies of EFV also showed that this drug was associated with a substantial reduction in the AUC for methadone (57%) and a significant reduction in the maximum concentration of methadone (48%). The results with nevirapine in this study were similar at 51% and 36%, respectively. Nevertheless, the authors suggest that the need for increased doses of methadone are not as significant as suggested due to "induction-detoxification." Their recommendation is that some patients on methadone maintenance programs will require an increase in the methadone dose, but not by as much as the pharmacology studies suggest. The usual need is a methadone dose increase of 16-22% at 7-10 days depending on symptoms.
posted 11/19/2001





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