UKRAINS'KYI VISNYK PSYKHONEVROLOHII

The Scientific and Practical Journal of Medicine
ISSN 2079-0325(p)
DOI 10.36927/2079-0325

CLINICAL AND PHARMACOLOGICAL COMPATIBILITY OF METHADONE AND ANTIVIRAL AGENTS FOR THE TREATMENT OF VIRAL HEPATITIS

Type of Article

In the Section

Index UDK:

Abstract

The aim of this study was to determine the clinical and pharmacological compatibility of methadone with modern direct antiviral agents (DAAs) in the treatment of chronic viral hepatitis in patients with opioid dependence. Methadone maintenance therapy is an effective approach to reducing the prevalence of HIV/AIDS; however, the risk of hepatitis virus infection among drug-dependent individuals exceeds 80 %, necessitating combined treatment. Bibliosemantic, analytical, statistical, and graphical methods were used, along with certified protocols from DrugBank and Hep Drug Interactions databases. It was established that entecavir, tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) do not interact with the CYP450 system and are compatible with methadone, ensuring safe therapy of hepatitis B virus (HBV). Direct-acting antivirals against hepatitis C virus (HCV) — sofosbuvir/velpatasvir, glecaprevir/ pibrentasvir — likewise do not affect methadone pharmacokinetics and can be administered within opioid substitution programs. In contrast, peginterferons α-2a and α-2b increase serum methadone concentrations by 10—15 %, and in rare cases up to 100 %, leading to potential toxicity and cardiac complications (QT prolongation, torsades de pointes). Ursodeoxycholic acid may theoretically induce CYP3A4 and alter methadone absorption, although the clinical relevance remains uncertain. Thus, most current DAAs can be safely co-administered with methadone, while interferon-based therapy requires careful monitoring and possible dose adjustmen

Pages

References

  1. Narcology: current issues / [Mishiev V. D., Sosin I. K., Ovcharenko O. A., Yershova O. A.]. Lviv: World Medicine, 2010. 277 p. Mishyiev V. D., Sosin I. K., Ovcharenko M. O., Yershova O. A. [Narcology: current issues]. Lviv: World Medicine, 2010. 277 p. (In Ukrainian).
  2. Ovcharenko M. O. Results of variance, discriminant, and cluster analysis in assessing the influence of comorbid chronic hepatitis C activity on biochemical serum parameters in patients with opioid dependence // Ukrainian Journal of Clinical and Laboratory Medicine. 2011. Vol. 6, No. 1. Pp. 203–209. Ovcharenko M. O. Results of variance, discriminant and cluster analysis in assessing the influence of comorbid chronic hepatitis C activity on biochemical parameters of blood serum in patients with opioid dependence [Ukrainian Journal of Clinical and Laboratory Medicine]. 2011;6(1):203–209. (In Ukrainian).
  3. Toma D, Anghel L, Patraș D, Ciubară A. Hepatitis C virus: epidemiological challenges and global strategies for elimination. Viruses. 2025;17(8):1069. doi: https://doi.org/10.3390/v17081069
  4. Shengelaia L, Anderson EJ, Butsashvili M, Gulbiani L, Kanchelashvili G, Dehovitz J, et al. Hepatitis C virus reinfection among people who inject drugs in the country of Georgia and injection-related risk factors: implications for HCV elimination in the EECA region. PLoS One. 2025;20(9):e0330764. doi: https://doi.org/10.1371/journal.pone.0330764
  5. Yela E, Abiétar DG, Clua-García R. How to eliminate hepatitis C between people who inject drugs in community services and prisons in Catalonia. Harm Reduction Journal. 2025;22:133. doi: https://doi.org/10.1186/s12954-025-01286-w
  6. Miller LS, Rao A, Tunnell K, Wang YF, Parsons R, McLendon K, et al. Independent assessment of a point of care HCV RNA test by laboratory analytical testing and a prospective field study in the U.S. PLoS One. 2025;20(7):e0324088. doi: https://doi.org/10.1371/journal.pone.0324088
  7. Lu X, Yue  Q, Jing H, Zhong G, Ning Z, Du  J, et  Machine learning model for predicting hepatitis C seroconversion in methadone maintenance patients in China. BMJ Public Health. 2025;3(2):e002290. doi: https://doi.org/10.1136/bmjph-2024-002290
  8. Jang SC, Lo-Ciganic WH, Hernandez-Con P, Jenjai C, Huang J, Stultz A, et al. Development and validation of a machine learning–based screening algorithm to predict high-risk hepatitis C infection. Open Forum Infectious Diseases. 2025;12(8):ofaf496. doi: https://doi.org/10.1093/ofid/ofaf496
  9. Boudova S, Iyer NS, Tholey DM, Fenkel JM, Boelig RC. The effect of HCV on methadone dose during pregnancy. Journal of Viral Hepatitis. 2025;32(9):e70060. doi: https://doi.org/10.1111/jvh.70060
  10. Guyatt P, Babe G, Gayowsky A, Rosic T, Rodrigues M, Bach P, et al. Impact of hepatitis C serostatus on health service utilization for opioid-related harms among individuals prescribed opioid agonist therapy: a longitudinal prospective cohort study. Drug and Alcohol Dependence Reports. 2025;16:100368. doi: https://doi.org/10.1016/j.dadr.2025.100368
  11. Zanette M, Min JE, Homayra F, Bach P, Socías ME, Bruneau J, et al. Comparative effectiveness of maintenance doses of opioid agonist treatment among individuals with opioid use disorder: a target trial emulation protocol using a populationbased observational study. BMJ Open. 2025;15(8):e098439. doi: https://doi.org/10.1136/bmjopen-2024-098439
  12. Walwyn WM, Miotto KA, Evans CJ. Opioid pharmaceuticals and addiction: the issues, and research directions seeking solutions. Drug Alcohol Depend. 2010 May 01;108(3):156-65. doi: https://doi.org/10.1016/j.drugalcdep.2010.01.001
  13. Toce MS, Chai PR, Burns MM, Boyer EW. Pharmacologic Treatment of Opioid Use Disorder: a Review of Pharmacotherapy, Adjuncts, and Toxicity. J Med Toxicol. 2018 Dec;14(4):306-322. doi: https://doi.org/10.1007/s13181-018-0685-1
  14. Salsitz E, Wiegand T. Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”. J Med Toxicol. 2016 Mar;12(1):58-63. doi: https://doi.org/10.1007/s13181-015-0517-5
  15. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020 Mar/Apr;14(2S Suppl 1):1-91. doi: https://doi.org/10.1097/ADM.0000000000000633
  16. Hong J, Lee J, Totouom-Tangho H, Dunn NR, Swift RG. Methadone-Induced Hyperhidrosis Treated With Oxybutynin. J Addict Med. 2017 May/Jun;11(3):237-238. doi: https://doi.org/10.1097/ ADM.0000000000000300
  17. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020 Mar/Apr;14(2S Suppl 1):1-91. doi: https://doi.org/10.1097/ADM.0000000000000633
  18. Kreek MJ, Reed B, Butelman ER. Current status of opioid addiction treatment and related preclinical research. Sci Adv. 2019 Oct;5(10):eaax9140. doi: https://doi.org/10.1126/sciadv.aax9140
  19. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022 Nov 04;71(3):1- 95. doi: https://doi.org/10.15585/mmwr.rr7103a1
  20. Boon M, van Dorp E, Broens S, Overdyk F. Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events. Ann Palliat Med. 2020 Mar;9(2):542- 557. doi: https://doi.org/10.21037/apm.2019.12.09
  21. Kharasch ED, Regina KJ, Blood J, Friedel C. Methadone Pharmacogenetics: CYP2B6 Polymorphisms Determine Plasma Concentrations, Clearance, and Metabolism. Anesthesiology. 2015Nov;123(5):1142-53. doi: https://doi.org/10.1097/ALN.0000000000000867
  22. Boon M, van Dorp E, Broens S, Overdyk F. Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events. Ann Palliat Med. 2020 Mar;9(2):542- 557. doi: https://doi.org/10.21037/apm.2019.12.09
  23. Ershad M, Cruz MD, Mostafa A, Mckeever R, Vearrier D, Greenberg MI. Opioid Toxidrome Following Grapefruit Juice Consumption in the Setting of Methadone Maintenance. J Addict Med. 2020 Mar/Apr;14(2):172-174. doi: https://doi.org/10.1097/ADM.0000000000000535
  24. Feng XQ, Zhu LL, Zhou Q. Opioid analgesics-related pharmacokinetic drug interactions: from the perspectives of evidence based on randomized controlled trials and clinical risk management. J Pain Res. 2017;10:1225-1239. doi: https://doi.org/10.2147/JPR.S138698
  25. Perry D, Kirkwood JE, Doroshuk ML, Kelmer M, Korownyk CS, Ton J, Garrison SR. Opioid agonist therapy for opioid use disorder in primary versus specialty care. Cochrane Database Syst Rev. 2025 Sep 8;9(9):CD013672. doi: https://doi.org/10.1002/14651858. CD013672.pub2.
  26. Sulkowski M, Wright T, Rossi S, Arora S, Lamb M, Wang K, et al. Peginterferon alfa-2a does not alter the pharmacokinetics of methadone in patients with chronic hepatitis C undergoing methadone maintenance therapy. Clin Pharmacol Ther. 2005 Mar;77(3):214-24. doi: https://doi.org/10.1016/j.clpt.2004.10.001.
  27. Gupta SK, Sellers E, Somoza E, Angles L, Kolz K, Cutler DL. The effect of multiple doses of peginterferon alfa-2b on the steady-state pharmacokinetics of methadone in patients with chronic hepatitis C undergoing methadone maintenance therapy. J Clin Pharmacol. 2007 May;47(5):604-12. doi: https://doi.org/10.1177/0091270007299760
  28. Paumgartner G, Beuers U. Ursodeoxycholic acid in cholestatic liver disease: mechanisms of action and therapeutic use revisited. Hepatology. 2002 May;36(3):525-31. doi: https://doi.org/10.1053/jhep.2002.36088 . PMID:12198659.