I am on MMT(methadone maintenance treatment since 1996 and my dose was 95mg until the beginning of this year when I was coerced by an ignorant girlfriend to "get strong and stop using a crutch." I started a blind detox and got down to 70mg by May. At the same time my viral load increased to 1500 and my HIV specialist changed me to a regiment including Sustiva. The Sustiva affected me for the first 2 weeks, however, I didn't truly realize it until on night I began to hallucinate; The doc was asking me if perhaps I had an extra cup of coffee that day or smoked more cigarettes. GET REAL!

The doc switched me to Viramune & I have heard that I should be monitered for methadone serum levels. Because I was OK mentally, I realized that the Viramune was doing the same thing & I was going thru opiate withdrawal about 12 hours after dosing If I was at 70mg. of methadone and the efficacy cut it to 35mg.(?) is it a surprise that I got very very sick everyday. I have cut my Viramune by half and I'm feeling OK.

Can anybody tells me if this sounds like sound medical treatment? I'm looking for a Canadian website where you are supposed to be able to list 15 different drugs or more and you will get a list of warnings. Does anybody know of this site, can you direct me to it. You guys are terrific for doing this for us/me. God bless you. Thank you & this is really an urgent issue for me. Thanks. KC

Hey KC - I read your entire question - shortened it a bit for posting...

Yes - we know that viramune does lower methadone levels. And it is expected that Sustiva does the same. So you would need more Methadone to be kept at the same level. Without a blood test however - it is hard to know an exact equation of how much it should change for a person - we are all too different to have an exact formula.

However - what you write about taking only half the viramune sounds worrisome from the perspective of making that drug work for you. These drugs only work when they are at full dose - for the first two weeks it is recommended to take just one viramune per day - but then it is critical to get that dose up. That is done since initially taking one a day is the right amount - but then the liver enzymes get revved up, and the level of viramune (and other things like methadone) goes down... so we then double the viramune. To continue on one viramune per day risks having too low a level - and that just invites HIV to learn how to ignore that drug. And all the rest of them in that class most likely...

So I'd reconsider your approach ASAP. I'd suggest an increase in the methadone with full dose Viramune. And I don't know the web site you are asking about - perhaps one of the readers will know it...

good luck.

CC