Methadone Dose Change Due to Incivek

[Kim4436]

I just started the triple treatment yesterday.  I have been on methadone maintenance for 15 months and from what I've been reading the Incivek somehow uses your methadone faster and you will need a dosage change.  Has anyone had this same issue. My gastro said not to worry about this issue too much.  Just told me to keep track of symptoms but the side effect symptoms are the same as opiate withdrawal symptoms.  How do I know what is is a side effect of?  I am at 95 mg methadone/day and don't really want to increase but I don't want to get sick either. Has anyone on methadone maintenance had this issue?

[working dog]

does you doctor mean the side effects on triple are the same if your on methadone as someone thats not on methadone?....looks like a good thing to check into....my doctor recommends certain ads over other ads because of drug interactions...i'll bet a lot of folks take one thing or the other that blocks or impairs the absorption of the hep drugs without even knowing it...i tried to stay away from anything that would interfere with tx drugs including foods like grapefruits....good luck with tx.....billy

[hrsepwrguy]

Interactions between your selected drugs


methadone ↔ telaprevir

Applies to: methadone, Incivek (telaprevir)

MONITOR: Coadministration with telaprevir may decrease the plasma concentrations of methadone. The mechanism of interaction has not been described. In 15 study subjects, administration of methadone maintenance therapy (40 to 120 mg/day) in combination with telaprevir (750 mg every 8 hours for 7 days) decreased overall methadone plasma concentrations by approximately one-third compared to administration alone. For the pharmacologically active R(+) enantiomer of methadone, peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by an average of 29%, while trough plasma concentration (Cmin) decreased by an average of 31%. For the S(-) enantiomer, the Cmax and AUC decreased by an average of approximately 35% and Cmin decreased by an average of 40%.

MANAGEMENT: Caution is advised if telaprevir is prescribed to patients treated with methadone. Pharmacologic response to methadone should be closely monitored and the dosage adjusted accordingly, particularly following initiation or discontinuation of telaprevir in patients who are stabilized on their methadone regimen. Patients should be advised to notify their caregiver if they experience possible symptoms of methadone withdrawal such as restlessness, insomnia, sweating, lacrimation, and rhinorrhea.

http://www.drugs.com/interactions-check.php?drug_list=1578-0,3328-15346

[Dee1956]

I have a friend who was in your same situation. He did not experience any problems. The incivek may or may not decrease your dose and if it did it would be a small amount, I think I read a small percentage.  As your doctor said, I would not worry about it.  My friend did not experience any change in his methadone dose.
Everyone is different and while some will experience this others will not.  As your doctor suggested, just wait and see how you feel.  The Incivek, INF and riba is going to make you sick so it would be hard to tell the difference.
Take care, good luck
Dee

[Advocate1955]

I don't know anything about that, but you can look at your Incivek prescribing information, and it will tell you the effect of Incivek on Methadone.  It may be that your maintenance dose may need to be adjusted slightly to accommodate for that effect.
It probably will be harder to keep track of your side effects and determine what is a side effect of what, but you can expect some mild cold/flu symptoms, weakness, fatigue, possibly nausea, possibly chills, a rash, possibly diarrhea or anal rectal pain from the triple tx with Incivek.  Some of those symptoms may be similar to withdrawal side effects of Incivek changing the effect of Methadone, so it may be hard to differentiate.  And then there is the psychological component of both triple tx and Methadone to consider as you experience side effects.
I would also encourage you to write down your side effects so your doctor can help you determine what's what.  On the other hand I would also encourage you to drink a lot of water, take a walk outside, and do some light exercise each day to try to take your mind off of the side effects and focus on other things that will help you feel well.
Advocate1955