Nevirapine induced opiate withdrawal among injection drug users with HIV infection receiving methadone.

Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Nevirapine induced opiate withdrawal among injection drug users with HIV infection receiving methadone.

AIDS. 1999 May 28;13(8):957-62. Unique Identifier : AIDSLINE MED/99297587
Altice FL; Friedland GH; Cooney EL; Yale University AIDS Program, New Haven, Connecticut 06510-2283,; USA.

Abstract: BACKGROUND: Pharmacokinetic interactions complicate and potentially compromise the use of antiretroviral and other HIV therapeutic agents in patients with HIV disease. This may be particularly so among those receiving treatment for substance abuse. OBJECTIVE: We describe seven cases of opiate withdrawal among patients receiving chronic methadone maintenance therapy following initiation of therapy with the non-nucleoside reverse transcriptase inhibitor, nevirapine. DESIGN: Retrospective chart review. RESULTS: In all seven patients, due to the lack of prior information regarding a significant pharmacokinetic interaction between these agents, the possibility of opiate withdrawal was not anticipated. Three patients, for whom methadone levels were available at the time of development of opiate withdrawal symptoms, had subtherapeutic methadone levels. In each case, a marked escalation in methadone dose was required to counteract the development of withdrawal symptoms and allow continuation of antiretroviral therapy. Three patients continued nevirapine with methadone administered at an increased dose; however, four chose to discontinue nevirapine. CONCLUSION: To maximize HIV therapeutic benefit among opiate users, information is needed about pharmacokinetic interactions between antiretrovirals and therapies for substance abuse.

Keywords: JOURNAL ARTICLE Adult Anti-HIV Agents/*ADVERSE EFFECTS Case Report Drug Interactions Female Human HIV Infections/COMPLICATIONS/*DRUG THERAPY Male Methadone/THERAPEUTIC USE Middle Age Narcotics/THERAPEUTIC USE Nevirapine/*ADVERSE EFFECTS Opioid-Related Disorders/*COMPLICATIONS/REHABILITATION Retrospective Studies Substance Abuse, Intravenous/*COMPLICATIONS/REHABILITATION Substance Withdrawal Syndrome/*ETIOLOGY
991130
A99B1111

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