Methadone with Nialamide Interaction Details
Brand Names Associated with Methadone
- Diskets®
- Dolophine®
- Methadone
- Methadose®
- Methadose® Oral Concentrate
- Westadone®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 02, 2024
Interaction Effect
Increased risk of serotonin syndrome
Interaction Summary
Concomitant use of methadone and drugs that impair metabolism of serotonin, including MAO inhibitors intended to treat psychiatric disorders and also others, such as linezolid and IV methylene blue, has resulted in serotonin syndrome and may occur with recommended dosages. Opioid toxicity including respiratory depression and coma may also occur. The onset of symptoms of serotonin syndrome may occur within several hours to a few days of concomitant use. In a case report, a drug-addicted man being treated with methadone experienced serotonin syndrome 3 days following initiation of linezolid for MRSA sepsis . The use of methadone is not recommended in patients taking MAOIs or within 14 days of stopping MAOI treatment. Discontinue methadone if serotonin syndrome is suspected .
Severity
Major
Onset
Rapid
Evidence
Theoretical
How To Manage Interaction
Concomitant use of methadone and drugs that impair metabolism of serotonin, including MAO inhibitors intended to treat psychiatric disorders and also others, such as linezolid and IV methylene blue, has resulted in serotonin syndrome and may occur with recommended dosages. Opioid toxicity including respiratory depression and coma may also occur. The onset of symptoms of serotonin syndrome may occur within several hours to a few days of concomitant use. The use of methadone is not recommended in patients taking MAOIs or within 14 days of stopping MAOI treatment. Discontinue methadone if serotonin syndrome is suspected.
Mechanism Of Interaction
Additive serotonergic effect
Literature Reports
A) In a case report, a 39-year-old drug-addicted, HIV-positive man with sepsis, osteomyelitis, and multiple muscle abscesses experienced serotonin syndrome 3 days following initiation of linezolid 600 mg twice daily for MRSA infection of blood and purulent drainage from his right arm. He was receiving maintenance therapy with methadone 40 mg/day for opioid dependence. The patient became increasingly confused, disoriented, and agitated. He had generalized abdominal tenderness, pulse rate fluctuations between 95 and 120 beats/min, a score of 10 on the Glasgow Coma Scale, and was unable to sustain conversation. Neurologic evaluation revealed dilated reactive pupils, an increased tone in both legs, with brisk reflexes and clonus at both ankles without meningism. WBC count was 21.1 x 10(9)/L mostly neutrophils and C-reactive protein was 15 mg/dL Discontinuation of linezolid resulted in resolution of mental, autonomic, and neuromuscular symptoms. Linezolid was replaced by ciprofloxacin and rifampicin. The patient was treated with rehydration, steroids, and benzodiazepines which resulted in improvement over 48 hours. After 3 months of antibiotic therapy and 40 days after discharge, muscle abscesses had resolved .
Methadone Overview
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Methadone is used to relieve severe pain in people who are expected to need pain medication around the clock for a long time and who cannot be treated with other medications. It also is used to prevent withdrawal symptoms in patients who were addicted to opiate drugs and are enrolled in treatment programs in order to stop taking or continue not taking the drugs. Methadone is in a class of medications called opiate (narcotic) analgesics. Methadone works to treat pain by changing the way the brain and nervous system respond to pain. It works to treat people who were addicted to opiate drugs by producing similar effects and preventing withdrawal symptoms in people who have stopped using these drugs.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.