[CDFri]

Hello everyone im currently a methadone patient at a treatment center. ive been on and stable at 130mg of methadone daily for about 9 months now. I recently saw my doctor because i have just kinda been down lately and he suggested i try an anti-depressant. I said I would be willing to give it a try and he perscribed me Fluoxetine(Prozac) 20mg per day. my question is this, are there any interactions between anti-depressants and methadone or will this combination work fine together? will the methadone affect the prozac or will the prozac affect the methadone at all? thanks to anyone who answers and i appreciate and support all of you in your times of hardship.

[steve sponaugle]

Originally Posted by CDFri

Hello everyone im currently a methadone patient at a treatment center. ive been on and stable at 130mg of methadone daily for about 9 months now. I recently saw my doctor because i have just kinda been down lately and he suggested i try an anti-depressant. I said I would be willing to give it a try and he perscribed me Fluoxetine(Prozac) 20mg per day. my question is this, are there any interactions between anti-depressants and methadone or will this combination work fine together? will the methadone affect the prozac or will the prozac affect the methadone at all? thanks to anyone who answers and i appreciate and support all of you in your times of hardship.

Selective Serotonin Reuptake Inhibitors(SSRIs), including Fluoxetine (Prozac) and tricyclic antidepressants can both increase methadone blood levels, because methadone and these antidepressants are both metabolized or broken down, by the same 3A4 liver detoxification pathway.

Sadly, some methadone patients have died, due to combining methadone and antidepressants.

This study demonstrates the ability of sertraline, generic name for Zoloft, to increase methadone plasma level. Sertraline and other Selective Serotonin Reuptake Inhibitor antidepressants are metabolized by the liver CYP 450 3A4 detoxification pathway and slow breakdown of methadone. While the average methadone serum level increase for 31 methadone patients was 26%, AT LEAST ONE PATIENT HAD A 118 % METHADONE LEVEL INCREASE. These increases were measured 6 weeks, after the antidepressant was started. If you start an antidepressant, while you are on methadone, you need to be very careful, since a methadone overdose could result.

Steve Sponaugle
Research Director, Florida Detox
www.floridadetox.com

Am J Addict. 2000 Winter;9(1):63-9.
The effect of sertraline on methadone plasma levels in methadone-maintenance patients.
Hamilton SP, Nunes EV, Janal M, Weber L.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, NY 10032, USA. sh209@columbia.edu

The authors examine methadone plasma levels in 31 depressed methadone-maintained opiate addicts enrolled in a 12-week placebo-controlled, double-blind study of sertraline. Between baseline and week 6, patients on sertraline showed a mean increase in methadone plasma level/dose (P/D) ratio of 26% (SD = 43%, range -32% to +118%), while patients on placebo showed a mean decrease of 16% (SD = 27%, range -62% to +50%). This difference was significant (p < 0.02). The sertraline and placebo groups did not differ in reported side effects or methadone dose adjustments. Between weeks 6 and 12, methadone P/D in the sertraline group decreased back towards baseline, and the treatment groups did not differ significantly at week 12. The results suggest sertraline may produce a modest increase in methadone serum levels over the first six weeks of treatment. Depression and anxiety disorders are common in methadone-maintained patients. Serotonin uptake inhibitors are attractive choices for treatment due to their low toxicity and low abuse potential, but these agents variously inhibit isoenzymes responsible for the metabolism of methadone. Clinicians treating depressed or anxious methadone patients with second-generation antidepressants should monitor for clinical signs of increased or decreased methadone levels and consider monitoring serum methadone levels.