Usefulness of methadone plasma concentration measurement in patients receiving nevirapine or efavirenz.

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State: Public
Version: author
Serval ID
serval:BIB_674823703779
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Usefulness of methadone plasma concentration measurement in patients receiving nevirapine or efavirenz.
Journal
American Journal of Drug and Alcohol Abuse
Author(s)
Pelet A., Favrat B., Cavassini M., Eap C.B., Besson J., Monnat M.
ISSN
1097-9891 (Electronic)
ISSN-L
0095-2990
Publication state
Published
Issued date
2011
Peer-reviewed
Oui
Volume
37
Number
4
Pages
264-268
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
Objective: To determine methadone plasma trough and peak concentrations in patients presenting opiate withdrawal symptoms after introduction of nevirapine or efavirenz. To describe the disappearance of these symptoms after methadone titration based on plasma concentrations rather than on the symptoms. Methods: Nine patients undergoing highly active antiretroviral therapy (HAART) and either nevirapine or efavirenz treatment were monitored daily for opiate withdrawal in a specialized drug addiction center. Methadone dose was titrated daily, and plasma concentrations were measured. The data are retrospective (case series). Results: Several patients complained of symptoms such as nausea, vomiting, accelerated intestinal transit, or insomnia. Even after methadone titration based on clinical symptoms, patients and health-care providers trained in infectious disease did not classify these as withdrawal symptoms and considered them as the side effects of HAART or anxiety. Methadone plasma trough concentration showed low levels of (R)- and (R,S)-methadone. Further methadone dose adjustment according to plasma level resulted in the disappearance of these withdrawal symptoms. The daily methadone dose was split when the peak/trough (R)-methadone ratio was more than 2. Conclusions: When introducing efavirenz or nevirapine to patients undergoing methadone treatment, withdrawal symptoms should be monitored, especially those such as insomnia, vomiting, or nausea. Methadone plasma trough and peak measurements can be of value in preventing unnecessary side effects of HAART.
Pubmed
Web of science
Create date
26/08/2011 13:46
Last modification date
20/08/2019 15:22
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