Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment

Détails

ID Serval
serval:BIB_D9AFA531780D
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment
Périodique
Drug and alcohol dependence
Auteur(s)
Eap C.B., Bourquin M., Martin J., Spagnoli J., Livoti S., Powell K., Baumann P., Déglon J.
ISSN
0376-8716
Statut éditorial
Publié
Date de publication
2000
Peer-reviewed
Oui
Volume
61
Numéro
1
Pages
47-54
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't - Publication Status: ppublish
Résumé
Methadone is a 50:50 mixture of two enantiomers and (R)-methadone accounts for the majority of its opioid effect. The aim of this study was to determine whether a blood concentration of (R)-methadone can be associated with therapeutic response in addict patients in methadone maintenance treatment. Trough plasma concentrations of (R)-, (S)- and (R,S)-methadone were measured in 180 patients in maintenance treatment. Therapeutic response was defined by the absence of illicit opiate or cocaine in urine samples collected during a 2-month period prior to blood sampling. A large interindividual variability of (R)-methadone concentration-to-dose-to-weight ratios was found (mean, S.D., median, range: 112, 54, 100, 19-316 ng x kg/ml x mg). With regard to the consumption of illicit opiate (but not of cocaine), a therapeutic response was associated with (R)- (at 250 ng/ml) and (R,S)-methadone (at 400 ng/ml) but not with (S)-methadone concentrations. A higher specificity was calculated for (R)- than for (R,S)-methadone, as the number of non-responders above this threshold divided by the total number of non-responders was higher for (R,S)-methadone (19%) than for (R)-methadone (7%). The results support the use of therapeutic drug monitoring of (R)-methadone in cases of continued intake of illicit opiates. Due to the variability of methadone concentration-to-dose-to-weight ratios, theoretical doses of racemic methadone could be as small as 55 mg/day and as large as 921 mg/day to produce a plasma (R)-methadone concentration of 250 ng/ml in a 70-kg patient. This demonstrates the importance of individualizing methadone treatment.
Mots-clé
Adult, Drug Administration Schedule, Female, Humans, Male, Methadone, Middle Aged, Narcotics, Opioid-Related Disorders, Sensitivity and Specificity, Stereoisomerism
Pubmed
Web of science
Création de la notice
10/03/2008 11:54
Dernière modification de la notice
03/03/2018 21:53
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