Juluca and Methadone Injection Solution

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.

Talk to your doctor before using methadone together with rilpivirine. Combining these medications can increase the risk of an irregular heart rhythm that may be serious. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, or fast or pounding heartbeats during treatment with these medications. 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 CLOSELY: Methadone may cause dose-related prolongation of the QT interval. Theoretically, coadministration with other agents that can prolong the QT interval such as rilpivirine may result in additive effects and increased risk of ventricular arrhythmias including torsade de pointes and sudden death. High dosages of methadone alone have been associated with QT interval prolongation and torsade de pointes. In a retrospective study of 17 methadone-treated patients who developed torsade de pointes, the mean daily dose was approximately 400 mg (range 65 to 1000 mg) and the mean corrected QT (QTc) interval on presentation was 615 msec. The daily methadone dose correlated positively with the QTc interval. Fourteen patients had at least one predisposing risk factor for arrhythmia (hypokalemia; hypomagnesemia; concomitant use of a medication known to prolong the QT interval or inhibit the metabolism of methadone; and structural heart disease), but these were not predictive of QTc interval. It is not known whether any of the patients had congenital long QT syndrome.

Pharmacokinetically, coadministration of methadone and rilpivirine may modestly decrease the plasma concentrations of R(-) methadone and S(+) methadone. The proposed mechanism is induction of CYP450-mediated metabolism by rilpivirine. In 13 study subjects receiving individualized methadone dosages of 60 to 100 mg/day in combination with rilpivirine 25 mg once a day, R(-) methadone peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) decreased by 14%, 16% and 22%, respectively, while S(+) methadone Cmax, AUC and Cmin decreased by 13%, 16% and 21%, respectively. Methadone appeared to have no significant effect on the pharmacokinetics of rilpivirine based on data from historical controls.

MANAGEMENT: Caution is recommended when methadone is administered concomitantly with rilpivirine, particularly in the setting of chronic pain management or methadone maintenance for opioid dependency where high dosages may be employed, or if administered to patients with underlying risk factors. Patients should be advised to seek medical attention if they experience symptoms that could indicate the occurrence of torsade de pointes such as dizziness, palpitations, or syncope. No dosage adjustments are required when initiating rilpivirine therapy in patients stabilized on methadone. However, clinical monitoring is recommended, as methadone maintenance therapy may need to be adjusted in some patients.

Juluca

Generic Name: dolutegravir / rilpivirine

Brand name: Juluca

Synonyms: n.a.

What is Juluca?

Methadone Injection Solution

Generic Name: methadone

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

Synonyms: Methadone

What is Methadone Injection Solution?