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Methadone Interactions With Anti-HIV Drugs, Medications for Opportunistic Infections and Psychiatric Drugs

April 16, 1999

Because many medications for HIV and for the prevention of opportunistic infections are broken down by the same liver enzymes that metabolize (break down) methadone, these drugs may cause changes in the way you respond to your methadone dose.

Some drugs increase the effects of methadone; others decrease it. Methadone can have an effect on the strength of some anti-HIV drugs too. The effects that can happen when methadone and these other drugs mix together in your body are called "drug interactions."

It's important to tell both the physician who provides your HIV care and the doctor at your methadone clinic about all the medications you're taking so that your methadone dose can be adjusted to deal with these effects and make you as comfortable as possible. The PWA Health Group has a handout available, complete with references, for you to give to your physician(s) if he/she is interested in more information on these interactions. Call us at (212) 255-0520, or drop by.

The average dose of methadone at most American clinics is 50 milligrams or less -- but research shows that optimal doses for most people are 60-120 mg. If your dose is not comfortable for you, it is not "addictive behavior" to want one that is. Doses of up to 1,000mg have been used successfully.

People considering detoxing from methadone should be aware that this is probably not a good idea for most people with HIV. Methadone-maintained addicts have slower progression to AIDS than those who are not on methadone, and street drugs can increase progression if you relapse after detox. Also, withdrawal itself is stressful to the body, and this can increase HIV replication and disease progression.

The following are some of the known drug interactions with methadone. There may be others -- this area, like most involving drug users, hasn't been well-studied yet. If you add a new medication and find that your methadone dose is not "holding" you or that it makes you drowsy or over-medicated, tell the counselor at your clinic. If they refuse to adjust your medication to meet your needs, ask your HIV care physician to discuss it with them. You shouldn't have to suffer because of ignorance about drug interactions from some clinic staff.

Currently, Dr. Ron D'Amico is studying interactions between protease inhibitors and methadone at Beth Israel Medical Center for AIDS Clinical Trials Group (ACTG) study number 401. He is offering participants $575 and HIV medications. You must already be on methadone. For further information, call (212) 844-1970.

Drugs that may make methadone more potent (stronger)

Drugs with mixed/contradictory effects

Drugs which make methadone less potent (weaker)

Drugs which methadone makes stronger

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