Nevirapine-induced withdrawal symptoms in HIV patients on methadone maintenance programme: an alert

Otero, María‐José; Fuertes, Antonio B.; Sanchez, R.; Luna, Guillermo

doi:10.1097/00002030-199905280-00025

Cited by 53 publications

(21 citation statements)

References 4 publications

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“…Accordingly, methadone pharmacokinetic parameters, i.e., AUC 0-24h , trough serum methadone concentrations, R-/Smethadone enantiomer concentration ratio and methadone dose were altered after both nevirapine and efavirenz treatments [19][20][21][22][23], which were consistent with the results presented in this paper (Table 4). Apparently, the methadone dose of patients treated with nevirapine was not sufficiently increased, since both OOWS and SOWS scores were higher than those of controls ( Table 2).…”

Section: Discussionsupporting

confidence: 90%

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Increase of R-/S-Methadone Enantiomer Concentration Ratio in Serum of Patients Treated with Either Nevirapine or Efavirenz

Esteban

Pellín²,

Gimeno³

et al. 2008

DML

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An increased methadone enantiomer ratio (R/S) was associated to both nevirapine (179%, n=5) and efavirenz (36%, n=9) treatments when compared with that of controls (n=52). Additionally, in four follow-up patients, both R- and S-methadone normalized concentrations decreased (19%-93%) while R/S increased (22%-314%) following nevirapine/efavirenz treatment. R/S decreased (42%) after non-compliance with efavirenz treatment. Therefore, the methadone-maintenance-treatment outcome should be evaluated when patients are treated with drugs which are supposed to induce CYP3A4 and CYP2B6 isoforms.

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Section: Discussionsupporting

confidence: 90%

“…Following nevirapine and efavirenz treatment, decreased levels of methadone were found 4-10 days later [19,20]. Thus, opiate withdrawal syndrome occurred and, consequently, either methadone dose was increased [6,[19][20][21][22][23][24] or antiretroviral treatment (nevirapine and efavirenz) discontinued [25].…”

Section: Introductionmentioning

confidence: 99%

Increase of R-/S-Methadone Enantiomer Concentration Ratio in Serum of Patients Treated with Either Nevirapine or Efavirenz

Esteban

Pellín²,

Gimeno³

et al. 2008

DML

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“…First, methadone treatment was not significantly related to treatment failure or discontinuations, apparently in contrast with previous evidence. [22][23][24] Thus, it seems that methadone maintenance can potentially reduce the frequency of injecting heroin use and can potentially increase adherence, although some dose adjustments might be necessary. Second, in IDUs with steady response to therapy and in those experiencing treatment failure, the increase in CD4 1 lymphocytes count can be considered a general favorable effect and apparently independent by IDUs behaviour.…”

Section: Discussionmentioning

confidence: 99%

Factors Related to Virologic Failure among HIV-Positive Injecting Drug Users Treated with Combination Antiretroviral Therapy Including Two Nucleoside Reverse Transcriptase Inhibitors and Nevirapine

Zaccarelli

Barracchini

Longis

et al. 2002

AIDS Patient Care and STDs

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Treatment strategies in human immunodeficiency virus (HIV)-positive active injecting drug users (IDUs) must take into account their lifestyles, that often result in low adherence to therapy. The nonnucleoside reverse transcriptase inhibitors (NNRTI) offer simpler treatment regimens, but the appearance of drug resistance during treatment failure may cause high levels of cross-resistance to all NNRTIs. We adopted a combination therapy of two NRTIs and nevirapine (NVP) for treatment of IDU patients to evaluate its feasibility in such patients. From October 1998 to December 1999, demographic, clinical, and laboratory data from 80 IDUs on this regimen were collected. Fisher's exact test, Kaplan Meier method, and Cox model were used for statistical analysis. Overall, 20 IDUs discontinued the treatment because of side effects and 20 IDUs experienced treatment failure. Considering the treatment failure as an end point, 55.6% (95% confidence interval [CI]: 37.9%-72.6%) of patients was still undergoing treatment after 12 months compared to 44.6% (31.8%-58.6%) when discontinuation was also taken into account. An increasing trend over time was observed in the CD4+ lymphocyte count, among failing and nonfailing IDUs. By multivariate analysis, baseline HIV-RNA, treatment breaks and low adherence and active injecting drug use turned out to be significantly associated with treatment failure. Our results show that continuing injecting drug use and treatment breaks are the main factors that can lead to treatment failure in IDUs and easily to NNRTI class resistance.

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“…The bioavailability of methadone is reduced by the non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs nevirapine and efavirenz, and withdrawal has been reported necessitating increases in methadone dose in PLWH on methadone maintenance [43][44][45][46]. By contrast, delavrudine, another NNRTI, can increase the plasma levels of methadone.…”

Section: Drug Interactionsmentioning

confidence: 99%

The Issues Around Opioid Prescribing in HIV-Related Pain

Cox

2013

Pain Manage.

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SUMMARY Opioids are very useful analgesics but reports of abuse, addiction and occasionally death have led to an increase in scrutiny, particularly for chronic opioid therapy. The development of effective antiretroviral therapy has changed the focus of treatment of people living with HIV from palliative care to the management of a chronic disease. It is appropriate, therefore, to review the issues around opioid prescribing in HIV in light of this and recent research, and to review the guidance available. This review briefly examines the epidemiology of pain in people living with HIV and then the use and issues around strong opioid prescribing in this group.

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Nevirapine-induced withdrawal symptoms in HIV patients on methadone maintenance programme: an alert

Cited by 53 publications

References 4 publications

Increase of R-/S-Methadone Enantiomer Concentration Ratio in Serum of Patients Treated with Either Nevirapine or Efavirenz

Increase of R-/S-Methadone Enantiomer Concentration Ratio in Serum of Patients Treated with Either Nevirapine or Efavirenz

Factors Related to Virologic Failure among HIV-Positive Injecting Drug Users Treated with Combination Antiretroviral Therapy Including Two Nucleoside Reverse Transcriptase Inhibitors and Nevirapine

The Issues Around Opioid Prescribing in HIV-Related Pain

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