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Polypharmacy and Drug-Drug Interactions: Methadone

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Challenging Cases and Complication Management in Pain Medicine

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Abstract

Methadone is a potent opioid analgesic that is available in a racemic mixture of l-isomer, carrying the majority of opioid properties, and d-isomer, primarily related to NMDA receptor antagonist activity. Methadone is metabolized in the liver via CYP3A4 and, to a lesser extent, CYP2B6, CYP2D6, and CYP1A2. As a consequence this medication may have significant interactions with drugs that share the same metabolic pathway, sometimes contributing to increase of the toxic side effects of the methadone. QTc interval increase and significant sedation and respiratory depression are just a few of the devastating adverse events associated with methadone that account for the many reported deaths in recent years.

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Author information

Authors and Affiliations

  1. Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA

    Randall W. Knoebel Pharm.D., B.C.O.P.

  2. Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA

    David M. Dickerson M.D.

Authors
  1. Randall W. Knoebel Pharm.D., B.C.O.P.
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  2. David M. Dickerson M.D.
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Corresponding author

Correspondence to David M. Dickerson M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, Illinois, USA

    Magdalena Anitescu

  2. Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA

    Honorio T. Benzon

  3. Division of Pain Medicine, Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA

    Mark S. Wallace

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Knoebel, R.W., Dickerson, D.M. (2018). Polypharmacy and Drug-Drug Interactions: Methadone. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_2

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  • DOI: https://doi.org/10.1007/978-3-319-60072-7_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60070-3

  • Online ISBN: 978-3-319-60072-7

  • eBook Packages: MedicineMedicine (R0)

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