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Pharmacological Agents Interacting With Methadone

Time to read: 4 min

Information on NAMA’s website is not
intended as medical advice for individual problems. 

 Appropriate medical professionals
should be consulted regarding addiction and addiction recovery.

 

Pharmacologic
Agents

Clinical
Signs
and Symptoms

Comments

Drugs That Decrease Methadone Levels

Rifampin, phenytoin, carbamazepine, butabarbital
sodium, mephobarbital, phenobarbital, secobarbital, ethanol (chronic),
disulfiram, urinary acidifiers, ascorbic acid

Withdrawal signs

Disulfiram may decrease methadone levels but not
significantly. Not clinically problematic.

Drugs That Increase Methadone Levels

Cimetidine, diazepam, ethanol (acute), fluvoxamine
maleate, ketoconazole, urinary alkalinizers

Increased sedation and other opiate effects

Cimetidine can be used in patients with low trough
methadone levels to prolong action (note: must consider cimetidine
effects on other concurrent medications).

Drugs With Levels Affected by Methadone

Desipramine (DMI), zidovudine (AZT)

Possible increased toxicity of DMI and AZT

Methadone descreases DMI and AZT metabolism; may
increase side effects. Close clinical monitoring needed.

Other Opioid and Analgesic Agents

Naltrexone, malmefene,maloxone, buprenorphine,*
butorphanol,* dezocine,* nalbuphine,* pentazocine,* tramadol

Withdrawal signs

 

*

Pain-relievers with opioid-antagonist activity.

Synthetic analgesic (not considered opioid
antagonist, but does decrease levels of opiates).

Data from Stine and Kosten,
Addiction Treatment Forum,
Kalvik et al, and Nillson et al.

This chart
courtesy of MedScape

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