Drug interactions
Methadone + Verapamil
Severity: Moderate
Methadone and Verapamil: 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
Verapamil inhibits CYP3A4 and may increase methadone concentrations, with greater opioid effect and sedation. Methadone's cardiac effects are also relevant because verapamil slows AV conduction and heart rate, which may add to bradycardia-related torsades risk.
What this interaction means in plain words
Methadone and Verapamil 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.
Methadone belongs to Musculoskeletal; Verapamil belongs to Cardiovascular.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein by verapamil reducing methadone clearance, plus additive cardiac conduction effects.
What to do
Monitor for sedation, respiratory depression and bradycardia when verapamil is started, and reduce the methadone dose if needed. Obtain an ECG in patients with other QT risk factors.
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 Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
Frequently asked questions
Can I take Methadone with Verapamil?
MediHelp rates the interaction as moderate. Methadone and Verapamil 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. Verapamil inhibits CYP3A4 and may increase methadone concentrations, with greater opioid effect and sedation. Methadone's cardiac effects are also relevant because verapamil slows AV conduction and heart rate, which may add to bradycardia-related torsades risk.
How serious is the interaction between Methadone and Verapamil?
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 sedation, respiratory depression and bradycardia when verapamil is started, and reduce the methadone dose if needed. Obtain an ECG in patients with other QT risk factors.
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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