Drug interactions
Bosentan + Methadone
Severity: Moderate
Bosentan and Methadone: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Bosentan induces CYP3A4 and can lower methadone plasma concentrations. This may reduce analgesia or precipitate opioid withdrawal symptoms in patients on stable methadone maintenance.
What this interaction means in plain words
Bosentan and Methadone can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Bosentan belongs to Miscellaneous; Methadone belongs to Musculoskeletal.
Why it happens
Bosentan induces hepatic and intestinal CYP3A4, increasing methadone metabolism and lowering its exposure.
What to do
Monitor for withdrawal symptoms or loss of analgesic effect after starting bosentan and increase the methadone dose if needed. Reassess the dose if bosentan is stopped, because methadone levels may rise.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
Other interactions of Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
Frequently asked questions
Can I take Bosentan with Methadone?
MediHelp rates the interaction as moderate. Bosentan and Methadone can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Bosentan induces CYP3A4 and can lower methadone plasma concentrations. This may reduce analgesia or precipitate opioid withdrawal symptoms in patients on stable methadone maintenance.
How serious is the interaction between Bosentan and Methadone?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for withdrawal symptoms or loss of analgesic effect after starting bosentan and increase the methadone dose if needed. Reassess the dose if bosentan is stopped, because methadone levels may rise.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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