Methadone with Telaprevir Interaction Details
Brand Names Associated with Methadone
- Diskets®
- Dolophine®
- Methadone
- Methadose®
- Methadose® Oral Concentrate
- Westadone®
Brand Names Associated with Telaprevir
- Incivek®
- Telaprevir
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 02, 2024
Interaction Effect
Increased risk of QT prolongation; increased risk of opioid withdrawal symptoms
Interaction Summary
Concomitant use of methadone and other drugs that affect cardiac conduction such as telaprevir increases the risk of QT prolongation. Additionally concurrent use of methadone and certain antiretroviral agents with CYP3A4 inhibitory activity, has a paradoxical effect and may result in increased clearance or decreased plasma levels of methadone. In a drug interaction study, coadministration resulted in decreases in both R- and S-methadone Cmax, AUC, and Cmin . This may result in reduced efficacy of methadone and may cause a withdrawal syndrome. Monitor methadone-maintained patients receiving an antiretroviral therapy closely for evidence of withdrawal effects and adjust the methadone dose appropriately. Monitor the patient for the development of prolonged QT interval .
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Concomitant use of methadone and other drugs that affect cardiac conduction such as telaprevir increases the risk of QT prolongation. Additionally concurrent use of certain antiretroviral agents with CYP3A4 inhibitory activity, has a paradoxical effect and may result in increased clearance or decreased plasma levels of methadone. This may result in reduced efficacy of methadone and may cause a withdrawal syndrome. Monitor methadone-maintained patients receiving an antiretroviral therapy closely for evidence of withdrawal effects and adjust the methadone dose appropriately. Monitor the patient for the development of prolonged QT interval.
Mechanism Of Interaction
Additive effects on QT interval; unknown
Literature Reports
A) In a drug interaction study (n=15), concomitant administration of methadone maintenance therapy (40 to 120 mg daily) and telaprevir 750 mg every 8 hours for 7 days resulted in decreases in both R- and S-methadone Cmax, AUC and Cmin. The ratio estimate for R-methadone Cmax, AUC, and Cmin (with telaprevir to without telaprevir), respectively, was 0.71, 0.71, and 0.69 . Similarly, the ratio estimate for S-methadone Cmax, AUC, and Cmin (with telaprevir to without telaprevir), respectively, was 0.65, 0.64, and 0.6 .
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.
Telaprevir Overview
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Telaprevir is used along with two other medications (ribavirin [Copegus, Rebetol] and peginterferon alfa [Pegasys]) to treat chronic hepatitis C (an ongoing viral infection that damages the liver) in people who have not yet been treated for this condition or whose condition could not successfully be treated with ribavirin and peginterferon alfa alone. Telaprevir is in a class of medications called protease inhibitors. It works by decreasing the amount of hepatitis C virus (HCV) in the body. Telaprevir may not prevent the spread of hepatitis C to other people.
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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.