Interacciones de metadona con fármacos antiinfecciosos y sustancias de abuso

M. R. Moreno Brea, M. O Rojas Corrales, J. Gibert-Rahola, J. A. Mico

Resumen


Frecuentemente es necesario utilizar antiinfecciosos en pacientes tratados con metadona. Se han observado diversasinteracciones entre metadona y fármacos antiinfecciosos, siendo necesaria una especial vigilancia en caso detratamiento antirretroviral. Se ha descrito aumento de los niveles plasmáticos y de la toxicidad de zidovudina por metadona; también es posible el efecto contrario, es decir la disminución de los efectos del opiáceo por la zidovudina. Entre los inhibidores de la proteasa, ritonavir puede aumentar considerablemente los niveles plasmáticos de metadona y sus efectos depresores. Eritromicina o ketoconazol tienen efectos farmacocinéticos similares. Al contrario, se ha observado el desencadenamiento de síndrome de abstinencia debido a inducción metabólica originada por rifampicina. También las sustancias de abuso, frecuentemente utilizadas por estos pacientes, pueden originar interacciones farmacológicas. La significación clínica de la interacción alcohol/metadona no está clara, en ella pueden participar modificaciones en el metabolismo hepático. A pesar del extenso abuso de cocaína en estos pacientes, son poco conocidas las consecuencias de su consumo con metadona, en las que pudieran estar implicadas interacciones entre la neurotransmisión catecolaminérgica y opioidergica. Se requieren más estudios sobre cannabinoides, anfetaminas o drogas de diseño, de frecuente consumo en esta población.


Palabras clave


metadona; interacciones farmacológicas; drogas de abuso; alcohol; antiinfecciosos; nicotina

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Referencias


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DOI: https://doi.org/10.20882/adicciones.626

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