Methadone Reduced Nevirapine Pharmacokinetic Parameters in People Living With HIV in Malaysia
https://doi.org/10.47836/mjmhs.19.3.32
- Author:
Suzana Mustafa
1
;
Mahiran Mustafa
2
;
Wan Nazirah Wan Yusuf
3
,
4
Author Information
1. Department of Pharmacy, Hospital Raja Perempuan Zainab II, 15586 Kota Bharu, Kelantan, Malaysia
2. Infectious Disease Unit, Hospital Raja Perempuan Zainab II, 15586 Kota Bharu, Kelantan, Malaysia
3. Department of Pharmacology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia&
4. Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
- Publication Type:Journal Article
- Keywords:
Nevirapine, Methadone, Interaction, HIV, Pharmacokinetic
- From:Malaysian Journal of Medicine and Health Sciences
2023;19(No.3):247-253
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: The HIV epidemic in Malaysia predominantly affects males (90% of total HIV cases) mostly intravenous
drugs users. Nevirapine-based of highly active antiretroviral therapy (HAART) once- or twice-daily dosage improve
accessibility and effectiveness of antiretroviral treatment for HIV positive intravenous drug users (IDUs) receiving
methadone maintenance treatment. Studies reported that concomitant administration of nevirapine with methadone
reduced methadone plasma concentration. Since methadone and nevirapine were both known to be the substrate
for cytochrome 2B6 (CYP 2B6), concomitant use of both drugs may affect nevirapine concentration too. However,
methadone effect on nevirapine concentration is still unclear. This is a cross sectional study which reports how methadone co-administration affects the pharmacokinetic parameters of nevirapine in people living with HIV (PLHIV).
Methods: 112 patients receiving nevirapine-based antiretroviral drugs were recruited. Seventeen were maintained
with methadone without withdrawal symptoms. High-performance liquid chromatography was used to measure
plasma nevirapine concentrations. Nevirapine population pharmacokinetics was modelled with a non-parametric
approach using Pmetrics software. Result: According to univariate analysis, concurrent methadone administration increased the clearance of nevirapine by 25.3% (p = 0.046). Multivariate analysis showed that methadone medication
was independently linked with lower nevirapine concentrations and area-under-curve (Cmin was reduced by 15.2%,
p = 0.011, Cmax 19.5%; p = 0.003, AUC12 16.2%; p = 0.021 respectively). Conclusion: This study provides in-vivo
evidence of methadone co-administration reducing nevirapine exposure. Since a low concentration of nevirapine
will lead to treatment failure, monitoring is essential for PLHIV using both medications at the same time.
- Full text:11.2023my1532.pdf
