Voriconazole Methadone

Voriconazole. In a double-blind, placebo-controlled study in 23 patients taking methadone, voriconazole 400 mg twice daily for one day then 200 mg twice daily for 4 days increased the AUC ofi -methadone (active) by 47% and 5-methadone (inactive) by 103%. Methadone appeared to have no effect on voriconazole pharmacokinetics when compared with a reference study in healthy subjects. There were no signs or symptoms of significant opioid withdrawal or overdose and the combination was generally well tolerated. ... 

OPIOIDS ANTIFUNGALS 1, Ketoconazole T effect of buprenorphine 2. Fluconazole and itraconazole T the effect of alfentanil 3. Fluconazole and possibly voriconazole T effect of methadone this is a recognized pharmacokinetic effect but of uncertain clinical significance 1. Ketoconazole 1 the CYP3A4-mediated metabolism of buprenorphine 2.1 clearance of alfentanil 3.1 hepatic metabolism 1. The dose of buprenorphine needs to be 1 (by up to 50%) 2. i dose of alfentanil 3. Watch for T effects of methadone... 

Clinically important, potentially hazardous interactions with abacavir, atorvastatin, bepridil, bupropion, carbamazepine, clarithromycin, cyclosporine, dexamethasone, digoxin, felodipine, fluticasone propionate, fosamprenavir, itraconazole, ketoconazole, lovastatin, methadone, midazolam, nicardipine, nifedipine, phenobarbital, phenytoin, rifabutin, simvastatin, sirolimus, St John s wort, systemic lidocaine, tacrolimus, tenofovir, trazodone, vinblastine, vincristine, voriconazole, warfarin, zidovudine... 

Clinically important, potentially hazardous interactions with amiodarone, astemizole, bepridil, carbamazepine, chloroquine, cisapride, clarithromycin, dihydroergotamine, disopyramide, ergotamine, grapefruit juice, halofantrine, haloperidol, itraconazole, ketoconazole, methadone, moxifloxacin, phenobarbital, phenytoin, pimozide, procainamide, quinidine, rifampicin, ritonavir, sotalol, St John s wort, telithromycin, terfenadine, voriconazole... 

Several of the opioids (buprenorphine, hydromorphone, methadone) are metabolised by CYP3A, at least in part, and their metabolism is expected to be reduced by the azoles, which, to varying extents, inhibit CYP3A4. This has been seen when fluconazole and voriconazole are given with methadone, and when ketocona-zole is given with buprenorphine. It has been suggested that keto-conazole inhibits the metabolism of morphine and oxycodone, but evidence for this is sparse. 

Cardiovascular A 57-year-old man with HIV infection taking abacavir, nevirapine, tenofovir, voriconazole, and methadone developed new-onset seizures [69 ]. An electrocardiogram showed sinus bradycardia and a prolonged QT interval of 690 msec. He had several episodes of torsade de pointes and ventricular tachycardia, which resolved spontaneously. They were accompanied by altered cognition and... 

Fexofenadine Imatinib Irinotecan Loperamide Methadone Midazolam Nefazodone Nevirapine Omeprazole Paroxetine oral contraceptives Phenprocoumon Setraline Simvastine Tacrolimus Theophylline Tolbutamide Voriconazole Warfarin... 

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