Drug interactions
Methadone + Nevirapine
Severity: Major
Methadone and Nevirapine: major interaction.
Last updated Sources: US FDA label
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
Nevirapine induces hepatic metabolism of methadone and can lower its plasma concentrations. Patients on stable methadone maintenance may develop opioid withdrawal symptoms within days to weeks of starting nevirapine.
What this interaction means in plain words
Methadone and Nevirapine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Methadone belongs to Musculoskeletal; Nevirapine belongs to Anti Virals.
Why it happens
Nevirapine induces CYP3A4 and CYP2B6, increasing methadone clearance.
What to do
Monitor for withdrawal symptoms when nevirapine is started and increase the methadone dose as clinically needed. Reassess the dose if nevirapine is stopped, as methadone levels may rise again.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
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 Nevirapine
- Elbasvir / grazoprevir + Nevirapine Contraindicated
- Nevirapine + Ranolazine Contraindicated
- Nevirapine + St john's wort Contraindicated
- Abemaciclib + Nevirapine Major
- Acalabrutinib + Nevirapine Major
- Amobarbital + Nevirapine Major
Frequently asked questions
Can I take Methadone with Nevirapine?
MediHelp rates the interaction as major. Methadone and Nevirapine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Nevirapine induces hepatic metabolism of methadone and can lower its plasma concentrations. Patients on stable methadone maintenance may develop opioid withdrawal symptoms within days to weeks of starting nevirapine.
How serious is the interaction between Methadone and Nevirapine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for withdrawal symptoms when nevirapine is started and increase the methadone dose as clinically needed. Reassess the dose if nevirapine is stopped, as methadone levels may rise again.
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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