Methadone

Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); if for pain, reserve concomitant use in those for whom alternative options are inadequate or limit dosages/durations to minimum required; if for opioid addiction, manage concomitant use as clinically appropriate and closely monitor. Consider prescribing naloxone if concomitant use with benzodiazepines or other CNS depressants is warranted. During or within 14 days of MAOIs: not recommended. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT₃ antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. Potentiated by macrolides, azole antifungals, protease inhibitors, fluvoxamine, sertraline, and other CYP3A4, CYP2B6, CYP2C19, CYP2C9, or CYP2D6 inhibitors. Antagonized by rifampin, carbamazepine, phenytoin, St. John's Wort, phenobarbital, abacavir, amprenavir, darunavir+ritonavir, efavirenz, nelfinavir, nevirapine, ritonavir, telaprevir, lopinavir+ritonavir, saquinavir+ritonavir, tipranivir+ritonavir, and other CYP3A4, CYP2B6, CYP2C19, or CYP2C9 inducers. Caution with drugs that prolong the QT interval (eg, Class I and III antiarrhythmics, neuroleptics, TCAs, CCBs) and drugs capable of inducing electrolyte disturbances (eg, diuretics, laxatives, mineralcorticoid hormones). May potentiate zidovudine, desipramine. May antagonize diuretics, didanosine, stavudine; monitor. Paralytic ileus may occur with anticholinergics. Diphenhydramine, doxylamine, clomipramine, chlorpromazine, thioridazine, quetiapine, verapamil may cause false (+) methadone drug screens.

Increased risk of hypotension, respiratory depression, sedation with benzodiazepines or other CNS depressants (eg, non-benzodiazepine sedatives/hypnotics, anxiolytics, general anesthetics, phenothiazines, tranquilizers, muscle relaxants, antipsychotics, alcohol, other opioids); if for pain, reserve concomitant use in those for whom alternative options are inadequate or limit dosages/durations to minimum required; if for opioid addiction, manage concomitant use as clinically appropriate and closely monitor. Consider prescribing naloxone if concomitant use with benzodiazepines or other CNS depressants is warranted. During or within 14 days of MAOIs: not recommended. Risk of serotonin syndrome with serotonergic drugs (eg, SSRIs, SNRIs, TCAs, triptans, 5-HT₃ antagonists, mirtazapine, trazodone, tramadol, cyclobenzaprine, metaxalone, MAOIs, linezolid, IV methylene blue); monitor and discontinue if suspected. Avoid concomitant mixed agonist/antagonist opioids (eg, butorphanol, nalbuphine, pentazocine) or partial agonist (eg, buprenorphine); may reduce effects and/or precipitate withdrawal symptoms. Potentiated by macrolides, azole antifungals, protease inhibitors, fluvoxamine, sertraline, and other CYP3A4, CYP2B6, CYP2C19, CYP2C9, or CYP2D6 inhibitors. Antagonized by rifampin, carbamazepine, phenytoin, St. John's Wort, phenobarbital, abacavir, amprenavir, darunavir+ritonavir, efavirenz, nelfinavir, nevirapine, ritonavir, telaprevir, lopinavir+ritonavir, saquinavir+ritonavir, tipranivir+ritonavir, and other CYP3A4, CYP2B6, CYP2C19, or CYP2C9 inducers. Caution with drugs that prolong the QT interval (eg, Class I and III antiarrhythmics, neuroleptics, TCAs, CCBs) and drugs capable of inducing electrolyte disturbances (eg, diuretics, laxatives, mineralcorticoid hormones). May potentiate zidovudine, desipramine. May antagonize diuretics, didanosine, stavudine; monitor. Paralytic ileus may occur with anticholinergics. Diphenhydramine, doxylamine, clomipramine, chlorpromazine, thioridazine, quetiapine, verapamil may cause false (+) methadone drug screens.