title: Drug interactions between opioids and antiretroviral medications: interaction between methadone, LAAM, and nelfinavir.
abstract: Understanding drug interactions between antiretrovirals and opiate therapies may decrease toxicities and enhance adherence, with improved HIV outcomes in injection drug users. We report results of a clinical pharmacology study designed to examine the interaction of the protease inhibitor, nelfinavir, with methadone and LAAM (N = 48). Nelfinavir decreased methadone exposure, but no withdrawal was observed over the five day study period. LAAM and dinorLAAM concentrations were decreased, while norLAAM concentrations were increased, with minimal overall change in LAAM/metabolite exposure. Methadone and LAAM did not affect nelfinavir concentrations, but methadone decreased M8 metabolite exposure. While no toxicities were observed, clinicians should be aware of the potential for drug interactions when patients require treatment with nelfinavir and these opiate medications.
authors.affiliation: Medical College of Virginia, Virginia Commonwealth University, PO Box 980109, Richmond, VA 23298, USA. emccancekatz@vcu.edu
authors.forename: Elinore F
authors.initials: EF
authors.lastname: McCance-Katz
authors.forename: Petrie M
authors.initials: PM
authors.lastname: Rainey
authors.forename: Patrick
authors.initials: P
authors.lastname: Smith
authors.forename: Gene
authors.initials: G
authors.lastname: Morse
authors.forename: Gerald
authors.initials: G
authors.lastname: Friedland
authors.forename: Marc
authors.initials: M
authors.lastname: Gourevitch
authors.forename: Peter
authors.initials: P
authors.lastname: Jatlow
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy*; D000328:Adult; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D004347:Drug Interactions; D005260:Female; D017320:HIV Protease Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008691:Methadone / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008692:Methadyl Acetate / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009294:Narcotics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019888:Nelfinavir / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019966:Substance-Related Disorders / Q000150:complications* / Q000534:rehabilitation*
chemical_list: D017320:HIV Protease Inhibitors; D009294:Narcotics; D003577:Cytochrome P-450 Enzyme System; D019888:Nelfinavir; D008692:Methadyl Acetate; D008691:Methadone