title: Methadone withdrawal when starting an antiretroviral regimen including nevirapine.
abstract: Antiretrovirals from three drug classes, nucleoside analogs, nonnucleoside analogs, and protease inhibitors, can be combined to achieve viral suppression. The nonnucleoside analog nevirapine is an inducer of cytochrome P450 3A4 liver metabolism and has interactions with protease inhibitors and oral contraceptives. Methadone has two roles in human immunodeficiency viral infection: pain management and treatment of opioid abuse. A drug-drug interaction may result in decreased methadone blood levels when administered with nevirapine. A patient experienced methadone withdrawal symptoms when combining these agents.
authors.affiliation: Department of Pharmacy, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Heelon
authors.forename: L B
authors.initials: LB
authors.lastname: Meade
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System / Q000096:biosynthesis / Q000378:metabolism; D004347:Drug Interactions; D004790:Enzyme Induction / Q000187:drug effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008691:Methadone / Q000009:adverse effects* / Q000378:metabolism; D006899:Mixed Function Oxygenases / Q000096:biosynthesis / Q000378:metabolism; D019829:Nevirapine / Q000009:adverse effects* / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000201:enzymology / Q000209:etiology*
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D003577:Cytochrome P-450 Enzyme System; D019829:Nevirapine; D006899:Mixed Function Oxygenases; C104464:CYP3A protein, human; D051544:Cytochrome P-450 CYP3A; D008691:Methadone