Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment
Details
Serval ID
serval:BIB_D9AFA531780D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment
Journal
Drug and alcohol dependence
ISSN
0376-8716
Publication state
Published
Issued date
2000
Peer-reviewed
Oui
Volume
61
Number
1
Pages
47-54
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't - Publication Status: ppublish
Abstract
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.
Keywords
Adult, Drug Administration Schedule, Female, Humans, Male, Methadone, Middle Aged, Narcotics, Opioid-Related Disorders, Sensitivity and Specificity, Stereoisomerism
Pubmed
Web of science
Create date
10/03/2008 11:54
Last modification date
20/08/2019 16:59