Selected Nucleoside Analogues/Levomethadone; Methadone Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Methadone may decrease how much didanosine and stavudine your body absorbs. Methadone may slow down how quickly your liver processes zidovudine.

What might happen:

The amount of didanosine and stavudine in your blood may decrease and they may not work as well against your HIV-infection.The amount of zidovudine in your blood may increase and cause more side effects than normal.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. Your doctor may want to change the dose of your HIV-medicine. If you are taking didanosine and/or stavudine, your doctor may want to run some tests to make sure your medicines are working. If you are taking zidovudine, let your doctor know if you have any skin rashes, fever, sore throat, increased tiredness, weakness, unusual bleed or bruising, stomach pains, problems breathing, a change in urine color to brown, or changes in skin or eye color to yellow.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Rainey PM, Friedland G, McCance-Katz EF, Andrews L, Mitchell SM, Charles C, Jatlow P. Interaction of methadone with didanosine and stavudine. J Acquir Immune Defic Syndr 2000 Jul 1;24(3):241-8.
  • 2.Videx (didanosine) US prescribing information. Bristol-Myers Squibb Company November, 2011.
  • 3.Videx EC (didanosine) US prescribing information. Bristol-Myers Squibb Company January 25, 2018.
  • 4.Trapnell CB, Klecker RW, Jamis-Dow C, Collins JM. Glucuronidation of 3'-azido-3'-deoxythymidine (zidovudine) by human liver microsomes: relevance to clinical pharmacokinetic interactions with atovaquone, fluconazole, methadone, and valproic acid. Antimicrob Agents Chemother 1998 Jul;42(7):1592-6.
  • 5.Levopidon (levomethadone) Swedish Summary of Product Characteristics. DNE Pharma AS November 30, 2018.
  • 6.Dolophine (methadone hydrochloride) US prescribing information. Wast-Ward Pharmaceuticals Corp. October, 2019.
  • 7.McCance-Katz EF, Rainey PM, Jatlow P, Friedland G. Methadone effects on zidovudine disposition (AIDS Clinical Trials Group 262). J Acquir Immune Defic Syndr Hum Retrovirol 1998 Aug 15;18(5):435-43.
  • 8.Burger DM, Meenhorst PL, ten Napel CH, Mulder JW, Neef C, Koks CH, Bult A, Beijnen JH. Pharmacokinetic variability of zidovudine in HIV-infected individuals: subgroup analysis and drug interactions. AIDS 1994 Dec; 8(12):1683-9.
  • 9.Schwartz EL, Brechbuhl AB, Kahl P, Miller MA, Selwyn PA, Friedland GH. Pharmacokinetic interactions of zidovudine and methadone in intravenous drug-using patients with HIV infection. J Acquir Immune Defic Syndr 1992; 5(6):619-26.
  • 10.Rainey PM, Friedland GH, Snidow JW, McCance-Katz EF, Mitchell SM, Andrews L, Lane B, Jatlow P. The pharmacokinetics of methadone following co-administration with a lamivudine/zidovudine combination tablet in opiate-dependent subjects. Am J Addict 2002 Winter;11(1):66-74.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.