Pharmacokinetic drug interactions and adverse consequences between psychotropic medications and pharmacotherapy for the treatment of opioid dependence.
BACKGROUND
Psychiatric comorbidities among opioid-dependent patients are common. Many medications used to treat both conditions are metabolized through complimentary cytochrome P450 isoenzymes. When medication-assisted treatment for opioid dependence is concurrently used with psychotropic medications, problematic pharmacokinetic drug interactions may occur.


METHODS
We reviewed relevant English language articles identified through the MedLine, Scopus, and Embase databases from 1950 to December 2009 using the specific generic names of medications and keywords such as pharmacokinetics and drug interactions with buprenorphine, methadone, and naltrexone. Selected references from these articles were reviewed. Additionally, a review was conducted of abstracts and conference proceedings from national and international meetings from 1990 to 2009. A total of 60 studies were identified and reviewed.


RESULTS
Clinical case series and carefully controlled pharmacokinetic interaction studies have been conducted between methadone, buprenorphine, or naltrexone and some psychoactive medications. Important pharmacokinetic drug interactions have been demonstrated within each class of medications affecting either methadone and buprenorphine or psychoactive drugs. Few studies, however, have been conducted with naltrexone.


CONCLUSIONS
Several interactions between methadone, buprenorphine, or naltrexone and psychoactive medications are described and may have important clinical consequences. To optimize care, clinicians must be alerted to these interactions.
Yale University AIDS Program, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT 06510, USA.
Ali S
AS
Saber-Tehrani
Robert Douglas
RD
Bruce
Frederick L
FL
Altice
D004347:Drug Interactions; D006801:Humans; D009292:Narcotic Antagonists / Q000009:adverse effects*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D011619:Psychotropic Drugs / Q000009:adverse effects*
D009292:Narcotic Antagonists; D011619:Psychotropic Drugs