AboutDr Mohd Tariq Salman Expertise I can answer questions related to indications (therapeutic uses), contraindications, adverse reactions and interactions of drugs. I can also give expert opinion on queries related to rational use of medicines, including cost effective medication, essential medicines and generic drugs.
Experience Teaching and training of undergraduate medical, dental and pharmacy students, supervision of pharmacology residents and research on herbal drugs, pharmacovigilance and drug utilization studies.
Organizations Era's Lucknow Medical College, Jawaharlal Nehru Medical College, Indian Pharmacological Society, Society of Pharmacovigilance India, Association of Medical Pharmacologists of Imdia.
Publications British Journal of Clinical Pharmacology, JK Science, Natural Product Radiance, Hippocratic Journal of Unani Medicine, Indian Journal fot the Practicing Doctor, Unimed Kulliyat.
Question what are the drugs that you cannot take while on methadone? I know there are some that will start
Answer 1. Opioid Antagonists, Mixed Agonist/Antagonists, and Partial Agonists
Patients maintained on methadone may experience withdrawal symptoms. Examples - naloxone, naltrexone, pentazocine, nalbuphine, butorphanol, and buprenorphine.
2. Anti-retroviral Agents
Abacavir, amprenavir, efavirenz, nelfinavir, nevirapine, ritonavir, lopinavir+ritonavir combination - Coadministration resulted in increased clearance or decreased plasma levels of methadone.
Didanosine and Stavudine - Methadone decreased the AUC and peak levels for didanosine and stavudine.
Zidovudine - methadone increased the area under the concentration-time curve (AUC) of zidovudine which could result in toxic effects.
3. Cytochrome P450 Inducers
Rifampin-concomitant administration resulted in a marked reduction in serum methadone levels and a concurrent appearance of withdrawal symptoms.
Phenytoin - resulted in reduction in methadone exposure and withdrawal symptoms occurred concurrently.
St. John's Wort, Phenobarbital, Carbamazepine
Administration of methadone along with other CYP3A4 inducers may result in withdrawal symptoms.
4. Cytochrome P450 Inhibitors
Methadone-treated patients coadministered strong inhibitors of CYP3A4, such as azole antifungal agents (e.g., ketoconazole) and macrolide antibiotics (e.g., erythromycin), with methadone should be carefully monitored.
Some selective serotonin reuptake inhibitors (SSRIs) (e.g., sertraline, fluvoxamine) may increase methadone plasma levels upon coadministration with methadone and result in increased opiate effects and/or toxicity.
Voriconazole - Repeat dose administration of oral voriconazole increased the Cmax and AUC of (R)-methadone subjects receiving a methadone maintenance dose.
5.Monoamine Oxidase (MAO) Inhibitors
If the use of methadone is necessary in such patients, a sensitivity test should be performed in which repeated small, incremental doses of methadone are administered over the course of several hours while the patient's condition and vital signs are under careful observation.
6. Desipramine - Blood levels of desipramine have increased with concurrent methadone administration.
7. Potentially Arrhythmogenic Agents - interactions may occur with concomitant use of potentially arrhythmogenic agents such as class I and III antiarrhythmics, some neuroleptics and tricyclic antidepressants, and calcium channel blockers.
8. Caution should also be exercised when prescribing methadone concomitantly with drugs capable of inducing electrolyte disturbances (hypomagnesemia, hypokalemia) that may prolong the QT interval. These drugs include diuretics, laxatives, and, in rare cases, mineralocorticoid hormones.
9. Interactions with Alcohol and Drugs of Abuse
Methadone may be expected to have additive effects when used in conjunction with alcohol, other opioids or CNS depressants, or with illicit drugs that cause central nervous system depression. Deaths have been reported when methadone has been abused in conjunction with benzodiazepines.
