Dolophine and Irenka

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using methadone together with DULoxetine may increase the blood levels and effects of both medications. You may need a dose adjustment or more frequent monitoring by your doctor to safely use these medications. Let your doctor know if you experience excessive drowsiness, nausea, weakness, or difficult or shallow breathing, as they may be symptoms caused by increased levels of methadone. High blood levels of methadone can also occasionally cause an irregular heart rhythm that may be serious. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or fast or pounding heartbeats. Also let your doctor know if you have increased side effects of DULoxetine such as nausea, dry mouth, insomnia, drowsiness, constipation, or any unusual symptoms. If you have high blood pressure, you may need closer monitoring of your blood pressure when methadone is added to DULoxetine. Avoid activities requiring mental alertness such as driving or operating machinery until you know how these medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Coadministration of duloxetine and methadone may result in increased plasma concentrations of both drugs. The proposed mechanism is competitive inhibition of CYP450 2D6 metabolism. In one case report, a patient who had been receiving methadone 50 mg/day for approximately eight years for the treatment of heroin dependence complained of subjective symptoms of opioid overdose (sweating, drowsiness, fatigability, pruritus) a few days after the addition of duloxetine 60 mg/day. The symptoms improved immediately when the dosage of methadone was reduced to 40 mg/day two weeks later, and there was no recurrence when the dosage was increased back to 50 mg/day after two months. Although not reported in this patient, high plasma levels of methadone have been associated with QT interval prolongation and torsade de pointes arrhythmia.

Theoretically, duloxetine systemic exposure may also be increased by methadone. High plasma levels of duloxetine may increase the risk of serious adverse effects such as hypertension, hypertensive crisis, increased heart rate, orthostatic hypotension, syncope, and serotonin syndrome. Serotonin syndrome is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms may include mental status changes such as irritability, altered consciousness, confusion, hallucinations, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: Caution is advised if duloxetine and methadone are prescribed in combination. Pharmacologic response to methadone should be closely monitored and the dosage adjusted accordingly, particularly following initiation or discontinuation of duloxetine in patients who are stabilized on their methadone regimen. Patients should be advised to report excessive drowsiness, nausea, or asthenia to their physician, and to seek medical attention if they experience symptoms that could indicate the occurrence of torsades de pointes such as dizziness, palpitations, irregular heartbeat, shortness of breath, or syncope. Likewise, pharmacologic response to duloxetine should be monitored more closely whenever methadone is added to or withdrawn from therapy, and the dosage adjusted as necessary.

Dolophine

Generic Name: methadone

Brand name: Dolophine, Methadose, Methadose Sugar-Free, Diskets

Synonyms: n.a.

What is Dolophine?

Irenka

Generic Name: duloxetine

Brand name: Cymbalta, Irenka, Drizalma Sprinkle

Synonyms: n.a.

What is Irenka?