Abstract
Combination antiretroviral therapy including protease inhibitors such as ritonavir has added significant potency to therapy for human immunodeficiency viral (HIV) infection as well as substantial drug-drug interactions. Methadone metabolism is affected by cytochrome P450 (CYP) 3A4 inhibitors or inducers. Because ritonavir can induce CYP3A, it can decrease methadone plasma levels. An HIV-infected patient receiving methadone maintenance experienced withdrawal symptoms after ritonavir, saquinavir, and stavudine were added to his regimen; the most likely cause was ritonavir.
MeSH terms
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Analgesics, Opioid / metabolism*
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Anti-HIV Agents / adverse effects*
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Anti-HIV Agents / therapeutic use
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Diagnosis, Differential
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Drug Interactions
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Drug Therapy, Combination
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HIV Infections / complications
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HIV Infections / drug therapy*
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HIV Protease Inhibitors / adverse effects*
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HIV Protease Inhibitors / therapeutic use
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Humans
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Male
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Methadone / metabolism*
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Middle Aged
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Ritonavir / adverse effects*
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Ritonavir / therapeutic use
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Saquinavir / adverse effects
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Saquinavir / therapeutic use
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Stavudine / adverse effects
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Stavudine / therapeutic use
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Substance Withdrawal Syndrome / diagnosis
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Substance-Related Disorders / complications
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Substance-Related Disorders / rehabilitation
Substances
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Analgesics, Opioid
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Anti-HIV Agents
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HIV Protease Inhibitors
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Stavudine
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Saquinavir
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Ritonavir
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Methadone