methadone

[morphinestreet]

can someone please tell me if you go on methadone treatment , are you allowed to be on other meds including sleep pills , even if you have a valid prescription
or you have to be of everything
how does it work

 

[chugs]

It depends on what you're being prescribed. If its Mirtazapine then I think you should be ok considering that there have been studies with people on methadone taking Mirtazapine

However technically speaking Methadone does interact with a hell of a lot of drugs out there. Some drug users like to skate on thin ice by playing with those interactions however if you're on a high dose of methadone I think you should be cautioned to the extreme before entertaining such thoughts.

Methadone interacts with certain drugs, specifically:

(wow, NB; have a look at grapefruit juice....)

Alcohol
Status of interaction: Clinically important.
Effects:
Increased sedation.
Increased respiratory depression.
Combination may also have increased hepatotoxic potential.
Mechanism: Additive central nervous system depression.

Barbiturates
Status of interaction: Clinically important.
Effects:
Reduced Methadone levels.
Increased sedation.
Additive CNS depression.
Mechanism: Barbiturates stimulate hepatic enzymes involved in methadone maintenance.

Benzodiazepines
Status of interaction: Clinically important.
Effects: Enhanced sedative effect.
Mechanism: Additive CNS depression.

Buprenorphine
Status of interaction: Clinically important.
Effects: Antagonist effect or enhanced sedative and respiratory depression.
Mechanism: Buprenorphine is a partial agonist of opiate receptors.

Carbamazepine
Status of interaction: Clinically important.
Effects: Reduced methadone levels.
Mechanism: Carbamazepine stimulates hepatic enzymes involved in methadone metabolism.
Chloral hydrate
Status of interaction: Clinically important.
Effects: Enhanced sedative effect.
Mechanism: Additive CNS depression.

Chlormethiazole
Status of interaction: Clinically important.
Effects: Enhanced sedative effect.
Mechanism: Additive CNS depression.

Cimetidine
Status of interaction: Two cases have been shown in patients taking methadone as analgesia.
Effects: Possible increase in methadone plasma levels.
Mechanism: Cimetidine inhibits hepatic enzymes involved in methadone metabolism.

Ciprofloxacin
Status of interaction: Case in a patient taking methadone.
Effects: Enhanced sedative effect and respiratory depression requiring naloxone.
Mechanism: Probably by inhibiting hepatic enzymes involved in methadone metabolism.
Cisapride, domperidone and metoclopramide
Status of interaction: Theoretical.
Effects: Theoretically might increase the speed of onset of methadone absorption but not the extent.
Mechanism: Possibly by reversing the delayed gastric emptying associated with opioids.

Cyclazine and other sedating anti histamines
(cyclazine is not available in Australia)
Status of interaction: Clinically important.
Effects:
Anecdotal reports of injection of cyclazine with opioids causing hallucinations.
Reports of injections of high doses of dephenhydramine to achieve 'buzz'.
Mechanisms:
Additive psychoactive effects.
Anti muscarinic effects at high doses.

Desipramine
Status of interaction: Clinically important.
Effects: Raised desipramine levels by up to a factor of two.
Mechanism: Unknown mechanism not seen with other tricyclic antidepressants.
Other tricyclic antidepressants
Status of interaction: Theoretical.
Effects: Enhanced sedative effect which is dose dependent.
Mechanism: Additive CNS depression.

Disulfiram
Status of interaction: Avoid in combination with methadone formulations containing alcohol (check with manufacturer).
Effects: Very unpleasant reaction to alcohol which can be dangerous.
Mechanism: Disulfiram inhibits metabolism of alcohol allowing metabolites to build up.

Erythromycin
Status of interaction: In theory should interact but not been studied.
Effects: Increase in methadone levels.
Mechanism: Decreased methadone metabolism.

Fluconazole
In theory the same as ketoconazole.
Fluoxetine and sertraline
Status of interaction: Clinically important.
Effects: Raised methadone levels but not as significant as for fluvoxamine.
Mechanism: Decreased methadone metabolism.

Fluvoxamine
Status of interaction: Clinically important.
Effects: Raised plasma methadone levels.
Mechanism: Decreased methadone metabolism.
Other SSRIs
Status of interaction: Theoretical.
Effects: Raised plasma methadone levels.
Mechanism: Decreased methadone metabolism.

Grapefruit juice
Status of interaction: Should interact in theory and there have been several anecdotal reports.
Effects: Raised methadone levels.
Mechanism: Decreased methadone metabolism.
Indinavir
Status of interaction: Clinically important.
Effects: Raised methadone levels.
Mechanism: Decreased methadone metabolism.
Ketoconazole
Status of interaction: Clinically important.
Effects: Raised methadone levels.
Mechanism: Decreased methadone levels.
MAOI (including selegiline and moclobemide)
Status of interaction: Severe with pethedine though unlikely with methadone and has never been described.
Effects:
CNS excitation.
Delirium.
Hyperpyrexia.
Convulsions.
Hypotension or respiratory depression.
Mechanism: Unclear, avoid the combination if possible.
Meprobamate
Status of interaction: Clinically important.
Effects: Enhanced sedative and respiratory depressant effect.
Mechanism: Additive CNS depression.

Naltrexone
Status of interaction: Clinically important.
Effects: Blocks effect of methadone (long acting).
Mechanism: Opioid antagonist – competes for opiate receptors.

Naloxone
Status of interaction: Clinically important.
Effects: Blocks effects of methadone (short acting) but may be needed if overdose suspected.
Mechanism: Opioid antagonist – competes for opiate receptors.

Nevirapine
Status of interaction: Clinically important.
Effects: Decreased methadone levels.
Mechanism: Increased methadone metabolism.

Nifedipine
Status of interaction: Has been demonstrated in vitro only.
Effects:
Increased nifedipine levels.
No effect on methadone levels.
Mechanism: Methadone increases metabolism of nifedipine.

Omeprazole
Status of interaction: To date demonstrated only in animals.
Effects: Increased methadone levels.
Mechanism: Possibly an effect on methadone absorption from the gut.

Pentazocine
Effects: Antagonist effect or enhanced sedative and respiratory depression.
Mechanism: Pentazocine is a partial agonist of opiate receptors with weak antagonist effect.

Phenobarbitone
See barbiturates above.

Phenytoin
Status of interaction: Clinically important.
Effects: Reduced methadone levels.
Mechanism: Phenytoin stimulates hepatic enzymes involved in methadone metabolism.

Propanolol
Status of interaction: To date demonstrated only in animals. Significance in humans is not known. Exercise caution when co-administering.
Effects: Enhanced lethality of toxic doses of opioids.
Rifampicin
Status of interaction: Very important. Most patients are likely to be affected.
Effects: Reduced methadone levels.
Mechanism: Rifampicin stimulates hepatic enzymes involved in methadone metabolism.

Rifabutin
Status of interaction: Occasionally clinically important.
Effects: Decreased methadone levels.
Mechanism: Increased methadone metabolism.

Ritonavir
Status of interaction: Clinically important.
Effects: Ritonavir may decrease plasma methadone levels.
Mechanism: Increased methadone metabolism.

Thioridazine
Status of interaction: Clinically important.
Effects: Enhanced sedative effect which is dose dependent.
Mechanism: Enhanced CNS depression.
Other protease inhibitors
Status of interaction: Theoretical.
Effects: May raise or lower methadone plasma levels.
Mechanism: Inhibits methadone metabolism.
Urine acidifiers
e.g. ascorbic acid – vitamin C.Top of page
Status of interaction: Clinically important.
Effects: Reduced plasma methadone levels.
Mechanism: Increased urinary excretion of methadone.
Urine alkalisers
e.g. sodium bicarbonate.
Status of interaction: Clinically important.
Effects: Increased plasma methadone levels.
Mechanism: Reduced urinary excretion of methadone.

Zidovudine
Status of interaction: Clinically important.
Effects:
Raised plasma levels of zidovudine.
No effects on methadone levels.
Mechanism: Unknown.

Zopiclone
Status of interaction: Clinically important.
Effects: Enhanced sedative and respiratory depressant effect.
Mechanism: Additive CNS depression.
Other opioid agonists
Status of interaction: Clinically important.
Effects:
Enhanced sedative effect.
Enhanced respiratory depression.
Mechanism: Additive CNS depression.
Other CNS depressant drugs
(eg neuroleptics hyoscine)Top of page
Status of interaction: Clinically important.
Effects: Enhanced sedative effect which is dose dependent.
Mechanism: Additive CNS depression.

 

[morphinestreet]

thanks for the info
but my question was the rules of been on methadone , by the people who check your urine test

 

[Methadonia2010]

Hi I've been on it a long time, I take Benzo's and do urines and its fine, they mostly are concerned about illegals not prescribed. Generally its your doctor who does the Urine, not the Pharmacy re rules.

 

[pharmarat]

If you can find a prescriber who can take care of the methadone as well as your other medication, that would be ideal. It means that they will be able to identify any potentially unsafe interactions, and anything that comes up in the urine test shouldn't be a surprise. It's pretty common for people to get their methadone and benzos from the pharmacy at the same time, including those who do urine tests.

 

[chugs]

thanks for the info
but my question was the rules of been on methadone , by the people who check your urine test

Oh....I get it.

You want to be naughty and take drugs whilst on a program. Sure you can do that but invariably the urine testing will pick you and your lies up. The difference between clean urines and non-clean ones is that the degree of takeway of dosing your given. Its a real pisser to dose daily, or go every weekend. The cleaner you are the more flexibility you get.

Take valium. It has a half-life of 100 hours. Meaning that for over 200 hours you'll have detectable quantities into your urine.

They won't kick you off the program but they won't believe you when you want them to and they won't be flexible when you need it.

 

[morphinestreet]

Oh....I get it.

You want to be naughty and take drugs whilst on a program. Sure you can do that but invariably the urine testing will pick you and your lies up. The difference between clean urines and non-clean ones is that the degree of takeway of dosing your given. Its a real pisser to dose daily, or go every weekend. The cleaner you are the more flexibility you get.

Take valium. It has a half-life of 100 hours. Meaning that for over 200 hours you'll have detectable quantities into your urine.

They won't kick you off the program but they won't believe you when you want them to and they won't be flexible when you need it.

no i just wanted to know the rules of been on the program , i been told that you are not allowed any other prescriptions that might interfere with methadone

 

[AnythingEverything]

If you're dependant on Benzos and need to taper or need them for legitimate reasons there is no reason you can't stay on them on the program. Im on suboxone not methadone but methadone was also discussed and it didn't affect my Benzo taper. And im on a low dose of 20mg of diazepam on the subs but have tapered down from a much higher dose.

I have a friend on methdone and is on the same benzo dose as me. She is public, I am private.

 

[crackbaby]

thanks for the info
but my question was the rules of been on methadone , by the people who check your urine test

ask your clinic what their rules and protocols are. each place will differ which is why youll have to check out the rules where youre getting dosed.

 

[Kolorklimax]

They have introduced new rules in Victoria and I just got a urine test. I know all the things I'm prescribed I'm okay with (I have a permit for Ritalin) but I am curious about codeine. I don't abuse it (what would be the point) but if I'm on the rag/aunt flow visits etc would taking a few nurefen plus show up? Would it be a problem if it did? How do the urine tests work exactly, are they going to be set off by a poppy seed bagel?
It's a drag, I get that too many people die but turning up this morning and finding that I have to go to the pharmacy twice per week rather than the once I was previously was a big shock. I work eighty e hours a week, I feel that should be taken into account. I will be ringing the pharmacotherapy advocacy people I think, has anyone had anything to do with them?

 

[Crankinit]

I suspect codeine would show up if you were taking panadeine/nurofen+. I'm almost certain it once caused me to give a false positive for morphine, since I hadn't shot up in 5 or 6 days before the test, but I had been taking panadeine and N+ during that time.

That said, if you're on methadone then there's no way that the tiny amount of codeine in the pills is actually going to have any pain relieving effect, you'd be better off just swapping to regular panadol/nurofen and not worrying about it.

I've never interacted with any advocacy groups, but contacting one sounds like a good idea if they're arbitrarily reducing your take-away doses in a way that interferes with your life.

 

[crackbaby]

^agreed. Taking codeine on methadone won't achieve much at all. Save your money for candy or plain old ibuprofen or paracetamol if you need.

 

[shoo-bop]

I suspect codeine would show up if you were taking panadeine/nurofen+. I'm almost certain it once caused me to give a false positive for morphine, since I hadn't shot up in 5 or 6 days before the test, but I had been taking panadeine and N+ during that time.

That would probably have been a true positive, not a false positive. Your liver metabolises a small proportion of codeine into morphine, so if you'd been taking codeine for several days before the urine test, you almost certainly would have had morphine in your urine - only a small amount, but still above the detection threshold. Then again, if you'd used heroin 5-6 days before, there still could be a detectable trace of morphine in your body from that too: In cases of chronic use of high doses of heroin, I've seen urine tests come back with small traces (below threshold for "proving" use, but still detectable and measurable) 8-10 days after the most recent self-reported use.

 

[shoo-bop]

They have introduced new rules in Victoria and I just got a urine test. I know all the things I'm prescribed I'm okay with (I have a permit for Ritalin) but I am curious about codeine. I don't abuse it (what would be the point) but if I'm on the rag/aunt flow visits etc would taking a few nurefen plus show up? Would it be a problem if it did? How do the urine tests work exactly, are they going to be set off by a poppy seed bagel?

Since codeine is partially metabolised to morphine, that can be detected for a few days after taking over-the-counter codeine products, but that will be in the urine alongside codeine and other codeine metabolites. So when they do the first "immunoassay" test (a relatively sensitive, but sometimes inaccurate test that can have false positives), they'll get a positive results for "opiates" in general, but when they do the more accurate second stage of confirmation, they'll see that the combination of metabolites, and their relative levels, is consistent with having taken codeine, rather than morphine or heroin (if they know how to interpret the results, or if they make a false accusation based on a misinterpretation of the results, you'd have a defense). In the case of poppy seed bagels, it's true that as few as 2 average poppy seed bagels can make you test positive for opiates on the immunoassay for a few hours afterwards, but on the follow-up confirmation tests, they'll see that the codeine and morphine levels are way below the threshold where they can accuse you of "using" - you'd have to stuff at least 10-20 bagels into your stomach in the space of a few hours to exceed that threshold!

Interestingly, large doses of codeine can also cause false positives for buprenorphine, if they're testing for that.

 

[Halif2]

That would probably have been a true positive, not a false positive.

This is a good point, pharmocalogically speaking. Oh dear, it seems I've misspelled something. I hope that doesn't detract from the relevance of shoo=bop's point, which is solid. Shoop soop, yeah!

 

[Crankinit]

That would probably have been a true positive, not a false positive. Your liver metabolises a small proportion of codeine into morphine, so if you'd been taking codeine for several days before the urine test, you almost certainly would have had morphine in your urine - only a small amount, but still above the detection threshold. Then again, if you'd used heroin 5-6 days before, there still could be a detectable trace of morphine in your body from that too: In cases of chronic use of high doses of heroin, I've seen urine tests come back with small traces (below threshold for "proving" use, but still detectable and measurable) 8-10 days after the most recent self-reported use.

Yeah fair point, I was just trying to keep my post succinct. "False" in the sense that he was testing me to see if I had shot up in the last few days, and the truth was that I hadn't. It was only after I left the doctors office that I remembered that I'd taken the codeine, or I would have mentioned it. As it was, I think he suspected I was lying to him when I told him I hadn't shot up morphine in the last few days. Oh well, he was an asshole anyway

 

[JoeBloggs]

I didnt read all that but short answer YES, Ive been on done and subbie at various times and continued getting vals