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Curr HIV/AIDS Rep. 2010 Aug;7(3):152-60. doi: 10.1007/s11904-010-0048-2.

Methadone, buprenorphine, and street drug interactions with antiretroviral medications.

Author information

1
San Francisco General Hospital, University of California San Francisco, 1001 Potrero Avenue, Ward 93/95, San Francisco, CA 94110, USA. Valerie.Gruber@ucsf.edu

Abstract

While street drugs appear unlikely to alter the metabolism of antiretroviral (ARV) medications, several ARVs may induce or inhibit metabolism of various street drugs. However, research on these interactions is limited. Case reports have documented life-threatening overdoses of ecstasy and gamma-hydroxybutyrate after starting ritonavir, an ARV that inhibits several metabolic enzymes. For opioid addiction, methadone or buprenorphine are the treatments of choice. Because a number of ARVs decrease or increase methadone levels, patients should be monitored for methadone withdrawal or toxicity when they start or stop ARVs. Most ARVs do not cause buprenorphine withdrawal or toxicity, even if they alter buprenorphine levels, with rare exceptions to date including atazanavir/ritonavir associated with significant increases in buprenorphine and adverse events related to sedation and mental status changes in some cases. There are newer medications yet to be studied with methadone or buprenorphine. Further, there are many frequently used medications in treatment of complications of HIV disease that have not been studied. There is need for continuing research to define these drug interactions and their clinical significance.

PMID:
20532839
PMCID:
PMC2892618
DOI:
10.1007/s11904-010-0048-2
[Indexed for MEDLINE]
Free PMC Article

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