Methadone contraindications

Increased CNS depression may occur with opioids and other CNS depressants such as hypnotics and manufacturers of several opiates specifically mention that barbiturates can potentiate sedation, respiratory depression, and hypotension. A reduction in dosage may be required. One manufacturer of methadone contraindicates the use of the injection, but not the oral solution, with other CNS depressants including barbiturates however, other manufacturers warn of the potential for increased CNS depression, but do not contraindicate barbiturates. ... 

Contraindications to interferon alfa therapy include hepatic decompensation, autoimmune disease, and history of cardiac arrhythmia. Caution is advised in the setting of psychiatric disease, epilepsy, thyroid disease, ischemic cardiac disease, severe renal insufficiency, and cytopenia. Alfa interferons are abortifacient in primates and should not be administered in pregnancy. Potential drug-drug interactions include increased theophylline levels and increased methadone levels. Co-administration with didanosine is not recommended because of a risk of hepatic failure, and co-administration with zidovudine may exacerbate cytopenias. 

In studies of its use in treating alcohol, opioid, and nicotine dependence, naltrexone has not been reported to cause depression or dysphoria. Patients who complain of naltrexone-associated dysphoria often have co-morbid depressive disorders or depression resulting from opioid or alcohol withdrawal states (549). Co-morbid depression is not a contraindication to naltrexone. Small pilot studies have supported the use of naltrexone in combination with antidepressants for the treatment of patients with co-mor-bid depression. The risk of non-fatal overdose is significantly increased after naltrexone treatment, as a result of reduced tolerance, compared with patients taking substitution methadone (550). 

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