POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: gregftl on June 29, 2009, 11:19:21 am
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i have been taking Kaletra and Truvada now since 2002. i started Methadone maintenance treatment for opiate dependency last September. i was in a really bad car accident and was taking 180mg oxycontin plus 100mcg/hr. Fentynal patches.
i started methadone at 20mg and over a month went up to 85mg. before i started feeling better.
then a few months ago, i started having withdrawl symptoms again and had to raise my methadone to 100mg.
i know when taking kaletra, the amount of methadone is lowered in the blood and increases in dosage every few months is needed.
is there another protease inhibitor i can take that wont interact with methadone?
kaletra is great for me..no side effects and my t-cells are always around 1250-1300 and i have never had a detectable viral load...
but i don't want to keep increasing my methadone every few months.
i would appreciate any opinions, tips, etc.
i dose my methadone around 8:30am and take my kaletra at 5pm
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Reyataz
Opiates, Methadone and Buproprion:
Methadone levels do not appear to be affected by Reyataz. Reyataz levels are slightly but not significantly altered by Methadone. Anyone who is taking Methadone, Buprenorphine or Opiate drugs should discuss how anti-HIV drugs could affect either the drug levels of the HAART regimen or of the opiate related drugs. Little is known about drug interactions with the newer drug Buproprion. Sudden feelings of opiate withdrawal, or toxicity due to increased concentrations of anti-HIV drugs may lead to non-adherence to prescribed HAART regimens. There are several successful models of anti-HIV treatment for active and recovering substance users, including those using prescribed opiates, although a specialty team of health care providers may be needed.
http://www.atdn.org/simple/reyataz.html
Prezista is a good new PI, but it interacts with methadone.
But like any of this you should discuss it all with your HIV specialist. I think because you've already been on HIV meds that you'd have to take Norvir with Reyataz as a booster and I'm not sure what Norvir does with methadone.
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The PI effect on methodone is complex, partly to do with an induction effect of Norvir on liver enzyme pathways, but also the main PI, eg Kaletra ie lopinavir 400mg/Norvir 100 mg twice daily reduces methadone but Norvir 100mg twice-daily on its own seems not to.
Prezista 800mg with 100mg Norvir has about 1/3rd to half the methadone-reducing effect of Kaletra.
Reyataz (atazanavir) at 400mg has no significant interaction with methadone so this may be an option. The question of boosting needs thought, but you could eg do the Norvir every other day with 400mg Reyataz as a short term thing or daily with 300mg (the standard dose) and see how it goes.
The new integrase inhibitor, Isentress (raltegravir) has no interactions with methadone so this may be an option
Resistance profile will be key I guess.
- matt
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actually i checked out the interactions on here and it said that Prezista and Reyataz does not interact with methadone...
thanks for that link!
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actually i checked out the interactions on here and it said that Prezista and Reyataz does not interact with methadone...
thanks for that link!
Actually no, the link on aidsmeds states the following: Another painkiller, methadone, commonly used to treat drug heroin addiction, can interact with Prezista/Norvir. Methadone levels in the bloodstream can decrease when combined with Prezista/Norvir. Because of this, it might be necessary to increase the dose of methadone.
http://www.aidsmeds.com/archive/Prezista_1562.shtml
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The PI effect on methodone is complex, partly to do with an induction effect of Norvir on liver enzyme pathways, but also the main PI, eg Kaletra ie lopinavir 400mg/Norvir 100 mg twice daily reduces methadone but Norvir 100mg twice-daily on its own seems not to.
Prezista 800mg with 100mg Norvir has about 1/3rd to half the methadone-reducing effect of Kaletra.
Reyataz (atazanavir) at 400mg has no significant interaction with methadone so this may be an option. The question of boosting needs thought, but you could eg do the Norvir every other day with 400mg Reyataz as a short term thing or daily with 300mg (the standard dose) and see how it goes.
The new integrase inhibitor, Isentress (raltegravir) has no interactions with methadone so this may be an option
Resistance profile will be key I guess.
- matt
yeah thank you! the only good thing about the Kaletra is the lack of side effects...i don't have any at all..reyataz sounds good but do you know anyone who is on it and what side effects they have?
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Actually no, the link on aidsmeds states the following: Another painkiller, methadone, commonly used to treat drug heroin addiction, can interact with Prezista/Norvir. Methadone levels in the bloodstream can decrease when combined with Prezista/Norvir. Because of this, it might be necessary to increase the dose of methadone.
http://www.aidsmeds.com/archive/Prezista_1562.shtml
if you combine Prezista with Norvir then it will decrease methadone..but Prezista by itself wont
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Erm, but a decent drug level you need to use Prexista with Norvir...
Nerdy NATAP report on boosted darunavir/methadine interaction.
http://www.natap.org/2006/Glasgow/Glasgow_53.htm
The reduction after 7 days in the study of the end-of-dose methadone levels is not so huge compared to Kaletra.
- matt
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Erm, but a decent drug level you need to use Prexista with Norvir...
Nerdy NATAP report on boosted darunavir/methadine interaction.
http://www.natap.org/2006/Glasgow/Glasgow_53.htm
The reduction after 7 days in the study of the end-of-dose methadone levels is not so huge compared to Kaletra.
- matt
correct me if i am wrong...but Kaletra is Lopinavir (200mg) and Ritonivir (50mg) in one tablet and i take 4 a day..so that would be 200mg. of Ritonivir which is the drug responsible for the methadone decrease.
If i took Reyataz and added 100mg of Ritonivir, that would cut the dose in half compared to the Kaletra and less Ritonivir would mean less interaction between it and the methadone...is that correct?
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Yes and then some...
Methadone metabolism is affected by (1) Norvir, which has a mild effect on increasing methadone elimination from the body. This is dose dependent, so less Norvir = slower elimination of methadone = higher end of dose level of methadone = less chance of withdrawal.
But (2) other PIs also affect methadone, and lopinavir, the other drug in Kaletra, is reported as worst in this respect.
So yes, less Norvir should mean less withdrawal symptoms, but it also depends on the main PI. Some are better than others here. Prezista + 100mg Norvir should be better than Kaletra. Reyataz + 100mg Norvir should be better still. There's only one way to find out...
Hope this helps.
- matt
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PS - I am on Reyataz. I have no side effects, except perhaps an occasional yellow glaze to the eyes. It is kind on my stomach. Going by the approval studies the GI effects are milder than Kaletra, and it is kinder to lipids. Of course, this is not true for everyone. As I said before, there's only one way.... :D - matt
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i take 5mg of Methadone every 8 hours for pain. maybe you should try splitting up the dose instead of taking it all at once. I also take Norvir, Reyataz and Truvada.
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my doctor finally agreed to switch me to that new drug, Isentress (raltegravir) that Matt mentioned earlier. and combining it with Truvada which i was already on. i really hate to switch since my last labs showed 1277 T-Cells and undetectable viral load and my T-Cells have never been below 1100 nor have i ever had a vial load..but i am sick of feeling like $hit.
i wish i could dose twice a day Antibody...but the clinic i go to only allows once a day dosing..5mg? damn..and that helps with your pain? i am on 100mg methadone.
i was taking 180mg oxycontin plus 100mcg/hr. fentynal patches for my back pain..but i also have a very high tolerance for any drug.
thanks guys, especially you Matt..you seem very well educated and informed on HIV drugs.
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I am a nerd, but it helps sometimes
now, if I could only get a decent shag....
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i still experience pain at 5mg. i don't feel any withdrawal symptoms just break through pain. My Doctor wants to switch to Oxycontin and is checking if Ryan White will cover it for me. My tolerence is way down from what it used to be I could take 8 to 10 of 10/650 Hydrocodone a day and a few grams of heroin.
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Yes and then some...
Methadone metabolism is affected by (1) Norvir, which has a mild effect on increasing methadone elimination from the body. This is dose dependent, so less Norvir = slower elimination of methadone = higher end of dose level of methadone = less chance of withdrawal.
But (2) other PIs also affect methadone, and lopinavir, the other drug in Kaletra, is reported as worst in this respect.
So yes, less Norvir should mean less withdrawal symptoms, but it also depends on the main PI. Some are better than others here. Prezista + 100mg Norvir should be better than Kaletra. Reyataz + 100mg Norvir should be better still. There's only one way to find out...
Hope this helps.
- matt
so lopinavir, the other drug in kaletra, interacts more with methadone and causes blood levels of methadone to be lower than with norvir (ritonivir)? so lopinavir, the other drug in kaletra, interacts more with methadone and causes blood levels of methadone to be lower than with norvir (ritonivir)?
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Yes, lopinavir + ritonavir (ie Kaletra) seriously reduces methadone levels, more so than any other PI, with or without ritonavir
- matt
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Yes, lopinavir + ritonavir (ie Kaletra) seriously reduces methadone levels, more so than any other PI, with or without ritonavir
- matt
good, glad i am switching meds then...my doctor said it will take about a week for the methadone to reach the right levels in my body after i get off the kaletra.
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i still experience pain at 5mg. i don't feel any withdrawal symptoms just break through pain. My Doctor wants to switch to Oxycontin and is checking if Ryan White will cover it for me. My tolerence is way down from what it used to be I could take 8 to 10 of 10/650 Hydrocodone a day and a few grams of heroin.
yeah oxycontin is great for pain and also depression....i don't like hydrocodone (vicodin) was never strong enough...fentanyl patches work even better although they are much more addicting than even oxycontin..glad you don't have any withdrawal symptoms. opiate withdrawal is the worst experience i have ever been through and wish i would never have started taking oxycontin or fentanyl...but that is where the methadone maintenance treatment comes in. it has helped me getting back to normal and allowed me to function normally..
good luck and i hope oxycontin is covered because it is at least $400 a month and that's for the generic!
you can also try the 30mg. oxycodone tabs. it is the same ingredient as oxycontin, but it is not time released so it has to be taken every 4 hours or so..but they work excellent for pain..and the generic brand works as good as the brand name and it is really cheap..under $60 month for 60 tabs of the 30mg.
go to www.nulegacyrx.com and you can print out a card there which will give you a huge discount on any drug at walgreens or CVS.