Pharmacokinetic drug interactions between opioid agonist therapy and antiretroviral medications: implications and management for clinical practice.
BACKGROUND
Opioid dependence and HIV/AIDS are 2 of the most serious yet treatable diseases worldwide. Global access to opioid agonist therapy and HIV treatment is expanding but when concurrently used, problematic pharmacokinetic drug interactions can occur.


METHODS
We reviewed English, Spanish, French, and Italian language articles from 1966 to 2005 in Medline using the following keywords: HIV, AIDS, HIV therapy, antiretroviral therapy, HAART, drug interactions, methadone, and buprenorphine. Additionally, we reviewed abstracts from national and international meetings and conference proceedings. Selected references from these articles were reviewed as well.


RESULTS
Clinical case series and carefully controlled pharmacokinetic interaction studies have been conducted between methadone and most approved antiretroviral therapies. Important pharmacokinetic drug interactions have been demonstrated within each class of agents, affecting either methadone or antiretroviral agents. Few studies, however, have been conducted with buprenorphine. The metabolism of both therapies, description of the known interactions, and clinical implications and management of these interactions are reviewed.


CONCLUSIONS
Certain interactions between methadone and antiretroviral medications are known and may have important clinical consequences. To optimize care, clinicians must be alert to these interactions and have a basic knowledge regarding their management.
Bruce
R Douglas
RD
Yale University AIDS Program, 135 College Street, New Haven, CT 06511, USA. robert.bruce@yale.edu
Altice
Frederick L
FL
Gourevitch
Marc N
MN
Friedland
Gerald H
GH
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000701:Analgesics, Opioid / Q000493:pharmacokinetics*; D019380:Anti-HIV Agents / Q000493:pharmacokinetics*; D002047:Buprenorphine / Q000493:pharmacokinetics / Q000627:therapeutic use; D004347:Drug Interactions; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008691:Methadone / Q000493:pharmacokinetics / Q000627:therapeutic use
D000701:Analgesics, Opioid; D019380:Anti-HIV Agents; D002047:Buprenorphine; D008691:Methadone