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Potential ARV Interactions with Methadone and Buprenorphine

for Health Care Providers

Table 1. Potential ARV Interactions

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Methadone:

  • The following may ↓ methadone levels. Monitor for signs of opiate withdrawal. Dosage adjustment of methadone may be needed.
    • NRTIs: ABC
    • NNRTIs: EFV, NVP
    • PIs: ATV, DRV, FPV/r, LPV/r, NFV, SQV/r, TPV/r
  • DLV may ↑ methadone levels. Start methadone at low dosage, monitor for methadone toxicity.
  • Methadone may ↓ ddI levels. Dosage adjustment not established.

Buprenorphine:

  • PIs: May ↑ buprenorphine levels and ↑ risk of adverse effects.
  • EFV: May ↓ buprenorphine levels; monitor for signs of opiate withdrawal.
  • Dosage adjustment of buprenorphine may be needed.

From Substance Use
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009