Interactions between buprenorphine and antiretrovirals. I. The nonnucleoside reverse-transcriptase inhibitors efavirenz and delavirdine.
This study examined drug interactions between buprenorphine, an opioid partial agonist medication used in the treatment of opioid dependence, and the nonnucleoside reverse-transcriptase inhibitors (NNRTIs) efavirenz (EFV) and delavirdine (DLV). Opioid-dependent, buprenorphine/naloxone-maintained, human immunodeficiency virus (HIV)-negative volunteers (n=10 per NNRTI) participated in 24-h sessions to determine pharmacokinetics of buprenorphine and of buprenorphine with either EFV or DLV after administration of standard doses of either antiretroviral for 15 or 7 days, respectively. Opiate withdrawal symptoms, cognitive effects, and adverse events were determined before and after antiretroviral administration in opioid-dependent participants. The pharmacokinetics of NNRTIs in healthy control participants were used to determine the effect of buprenorphine on NNRTIs. EFV decreased the buprenorphine area under the concentration-time curve (P<.001). DLV increased buprenorphine concentrations (P<.001). Clinically significant consequences of these interactions were not observed. Buprenorphine did not alter antiretroviral pharmacokinetics. Adjustments of doses of either buprenorphine or EFV or DLV are not likely to be necessary when these drugs are administered for the treatment of opiate dependence and HIV disease.
McCance-Katz
Elinore F
EF
Virginia Commonwealth University, Richmond, USA. emccancekatz@vcu.edu
Moody
David E
DE
Morse
Gene D
GD
Friedland
Gerald
G
Pade
Patricia
P
Baker
Jennifer
J
Alvanzo
Anika
A
Smith
Patrick
P
Ogundele
Abayomi
A
Jatlow
Peter
P
Rainey
Petrie M
PM
D000328:Adult; D000480:Alkynes; D019540:Area Under Curve; D048588:Benzoxazines; D002047:Buprenorphine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003521:Cyclopropanes; D020008:Delavirdine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000493:pharmacokinetics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D010078:Oxazines / Q000493:pharmacokinetics* / Q000627:therapeutic use; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D018894:Reverse Transcriptase Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D009292:Narcotic Antagonists; D010078:Oxazines; D018894:Reverse Transcriptase Inhibitors; D002047:Buprenorphine; D020008:Delavirdine; C098320:efavirenz