Patient selection methadone

Paroxetine 20 mg/day, a selective CYP2D6 inhibitor, was given for 12 days to 10 patients on methadone maintenance (27). Eight were genotyped as CYP2D6 homozygous extensive metabolizers and two as poor metabolizers. Paroxetine increased the steady-state concentrations of //-methadone and. V-methadone, especially in the extensive metabolizers. 

The combined use of clonidine and naltrexone appears to allow successful withdrawal from long-term methadone therapy within 4-5 days of its abrupt withdrawal. Although patient selection may be an important consideration, the apparent success rate compares favorably with other methods and is achieved in a much shorter time (70). 

Appel PW, Joseph H, Kott A, Nottingham W, Tasiny E Habel E (2001). Selected in-treatment outcomes of long-term methadone maintenance treatment patients in New York State. The Mount Sinai Journal of Medicine, 68, 55-61... 

Naltrexone (t) 4 h active metabolite 13 h) is similar to naloxone but longer-acting, with duration of effect 1-3 days according to dose. It can be used orally to assist in the rehabilitation of ex-opioid abusers who are fully withdrawn (otherwise it will induce an acute withdrawal syndrome). A patient who then takes an opioid fails to experience the kick or euphoria, although naltrexone does not reduce craving as does the agonist methadone. This use of naltrexone requires careful selection and supervision of subjects. 

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