title: Drug interactions between buprenorphine, methadone and hepatitis C therapeutics.
abstract: BACKGROUND
  People who inject drugs (PWID) and other individuals with opioid use disorders have a dramatically higher prevalence of hepatitis C virus (HCV) infection than the general population. The availability of novel direct acting antivirals (DAAs) for the treatment of HCV infection with very high efficacy, improved tolerability and shortened treatment durations have led to global efforts to ramp up treatment for all HCV-infected individuals to prevent or delay complications of the disease. Individuals with opioid use disorders, including those on medication-assisted therapy such as methadone or buprenorphine, are a key demographic group that can benefit from HCV treatment given their high HCV prevalence; however, pharmacokinetic and pharmacodynamic drug interactions could blunt their utility.
  
  
  METHODS
  We performed a comprehensive literature review of published and unpublished data from PubMed database, relevant conference abstracts/proceedings and FDA approved drug package inserts, to review the pharmacokinetic (PK) profile and drug interactions between currently approved HCV DAAs and methadone and buprenorphine.
  
  
  CONCLUSIONS
  The paper highlights specific drug combinations which result in altered opioid drug levels including telaprevir/methadone, daclatasvir/buprenorphine, and Abbvie 3D combination regimen (paritaprevir, ritonavir, ombitasvir and dasabuvir)/buprenorphine. However, concurrent pharmacodynamics assessments did not reveal significant signs and symptoms of opioid withdrawal or toxicity that would preclude concurrent administration.
authors.affiliation: a Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Onyema
authors.initials: O
authors.lastname: Ogbuagu
authors.affiliation: a Yale University School of Medicine , New Haven , CT , USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Friedland
authors.affiliation: a Yale University School of Medicine , New Haven , CT , USA.|b Department of Medicine , Cornell Scott-Hill Health Center , New Haven , CT , USA.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Bruce
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D002047:Buprenorphine / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D004347:Drug Interactions; D006526:Hepatitis C / Q000188:drug therapy; D006801:Humans; D008691:Methadone / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D009293:Opioid-Related Disorders / Q000188:drug therapy; D015819:Substance Abuse, Intravenous / Q000188:drug therapy
chemical_list: D000998:Antiviral Agents; D002047:Buprenorphine; D008691:Methadone
keywords: Chronic pain; direct-acting antiviral agent; hepatitis C virus; opioid use disorder; opioids