| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) Methadone | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential for reduced methadone concentrations |
If coadministering, monitor for methadone efficacy |
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| Lenacapavir Methadone | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Unknown effect on methadone |
If initiating methadone in a person already on lenacapavir, start with lowest feasible dose and titrate to clinical effect. If initiating lenacapavir in a person stable on methadone, dose adjustment of methadone may be required. Monitor for clinical efficacy and adverse effects (e.g. sedation, respiratory depression). |
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| Ritonavir Methadone 1053 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Stable methadone dose | No significant effect |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
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| Ritonavir Methadone 1052 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Not clinically significant |
S-methadone AUC decreased 25%; R-methadone AUC decreased 20% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
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| Ritonavir Methadone 1051 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, methadone withdrawal) |
90 mg daily x 2 years | Methadone AUC decreased |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
|
| Darunavir Methadone 896 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | May decrease methadone effects (e.g. withdrawal) |
Not reported |
55-200 mg once daily (stable dose) | R-methadone: Cmax decrease 24%, AUC decrease 16%, Cmin decrease 15%; S-methadone: Cmax decrease 44%, AUC decrease 36%, Cmin decrease 40% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Atazanavir Methadone 801 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Potential decreased methadone effects (withdrawl, inadequate pain control, cravings) |
stable dose on d 1-15 | Total methadone Cmax decresed 15% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
|
| Tenofovir disoproxil fumarate Methadone 741 | Green: Administer standard doses | Administer standard doses | Not studied |
40-110 mg once daily (individual patients on stable dose) | No significant change |
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| Lamivudine Methadone 698 | Green: Administer standard doses | Administer standard doses | Not studied |
No significant change |
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| Abacavir Methadone 666 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Potential for decreased methadone effects (e.g., withdrawal) |
No significant change |
40 mg once daily; 90 mg once daily | Methadone clearance increased 22% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Rilpivirine Methadone 644 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Potentially decreased methadone effects (eg, withdrawal) |
No significant change |
60-100 mg daily | R-methadone AUC decreased 16%; Cmin decreased 22%; S-methadone AUC decreased 16%; Cmin decreased 21%; |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Nevirapine Methadone 583 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
stable dose: racemic methadone 35-220 mg daily; (R)-methadone 45-115 mg daily | racemic methadone AUC decreased 37%; (R)-methadone AUC decreased 44% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
|
| Nevirapine Methadone 582 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, methadone withdrawal; interaction observed one week into therapy |
Nevirapine AUC increased 26%; Cmax increased 21%; Cmin increased 35% |
Stable methadone maintenance | Methadone AUC decreased 46% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Nevirapine Methadone 581 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, methadone withdrawal) |
Nevirapine AUC increased 25%; Cmax increased 17%; Cmin increased 32% |
Stable methadone dose | Methadone AUC decreased 51%; Cmax decreased 36% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Nevirapine Methadone 580 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects |
Nevirapine AUC decreased 46%; Cmax decreased 42% |
stable dose | Not reported |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Etravirine Methadone 533 | Green: Administer standard doses | Administer standard doses | 60-130 mg daily | R-methadone: no significant effect; S-methadone: no significant effect |
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| Efavirenz Methadone 369 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
stable dose over period of 60 weeks | Methadone AUC decreased 39%; Cmax decreased 33%; Cmin decreased 44%EDDP (methadone metabolite) AUC decreased 14.5%; Cmax no significant change; Cmin no significant change |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 368 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
Not studied |
Methadone AUC decreased 57%; Cmax decreased 48% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 367 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
35-100 mg daily | Methadone AUC decreased 52%; Cmax decreased 45% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 366 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
35-100 mg daily | Methadone AUC decreased 52%; Cmax decreased 45% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 365 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
35-100 mg daily | Methadone AUC decreased 52%; Cmax decreased 45% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Elvitegravir Methadone 132 | Green: Administer standard doses | Administer standard doses | Not reported |
80-120 mg daily | No significant change in R-methadone or S-methadone |
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| Dolutegravir Methadone 102 | Green: Administer standard doses | Administer standard doses | Not studied |
16-150 mg | No significant change |
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| Fostemsavir Methadone 14 | Green: Administer standard doses | Administer standard doses | Not studied |
40-120mg once daily, individual dosing | Methadone R(-): Cmax increased 15%, AUC increased 13%. Methadone S(+): Cmax increased 15%, AUC increased 15%, Cmin increased 10%. Methadone (total): Cmax increased 25%, AUC increased 14%, Cmin increased 10% |
