0874-4890 0874-4890 S0874-48902010000300006 00 00 2010 00 00 2010 16 3 59 66

Interacções medicamentosas entre a metadona e os anti-retrovirais

 

Sara Oliveira*, Lima Monteiro*, Torres Freixo*, Ângela Venâncio**

*Centro Hospitalar de Vila Nova de Gaia/Espinho

**IDT – DRN – CRI de Braga

CONTACTOS

 

RESUMO

A metadona constitui, desde 1965, uma alternativa incontornável no tratamento da dependência de opiáceos. Entre os utilizadores de drogas injectáveis (UDI), os indivíduos infectados pelo vírus da imunodeficiência humana (VIH) constituem uma população particularmente vulnerável. Apesar de o tratamento com anti-retrovirais em UDI ser possível e eficaz, vários factores podem afectar negativamente o tratamento, nomeadamente a fraca adesão à terapia, as potenciais interacções medicamentosas entre anti-retrovirais, substituto opiáceo e drogas ilícitas, os efeitos adversos e o acesso limitado e frequentemente atrasado ao tratamento anti-retroviral. Em contrapartida, o tratamento da dependência de opiáceos tem sido associado a uma diminuição dos comportamentos de risco relacionados com o VIH. As interacções medicamentosas entre a metadona e os anti-retrovirais podem potenciar os efeitos tóxicos dos fármacos, diminuir a eficácia dos anti-retrovirais ou desencadear sintomas de privação opiácea, com consequente recaída no consumo de substâncias ilícitas e abandono da terapêutica. Dada a actualidade do tema, os autores propuseram-se fazer uma revisão da literatura no que respeita às interacções medicamentosas entre a metadona e os anti-retrovirais e à sua abordagem na prática clínica.

Palavras-chave: Metadona; Interacções Medicamentosas; Anti-retrovirais; VIH.

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RÉSUMÉ

La méthadone est, depuis 1965, une alternative incontournable dans le traitement de la dépendance aux opiacés. Parmi les utilisateurs de drogues injectables (UDI), les personnes infectées par le virus de l’immunodéficience humaine (VIH) constituent une population vulnérable. Malgré le fait qui un traitement par antirétroviraux s’avère possible et efficace envers les UDI, plusieurs facteurs peuvent affecter le traitement. Ces facteurs sont: une mau­vaise observance thérapeutique; des interactions médicamenteuses potentielles entre les antirétroviraux, la méthadone et les drogues illicites; les effets indésirables et l’accès limité et souvent tardif au traitement antirétroviral. Les interactions médicamenteuses peuvent potentialiser les effets toxiques et réduire l’efficacité des médicaments antirétroviraux ou déclencher des symptômes de sevrage aux opiacés, entrainant une rechute de la consommation et l’arrêt du traitement. Cet article a pour but de présenter l’essentiel de la littérature concernant les interactions médicamenteuses entre la méthadone et les médicaments antirétroviraux.

Mots-clé: Méthadone; Interactions Médicamenteuses; Médicaments Antirétroviraux; VIH.

 

ABSTRACT

Since 1965, methadone is a cornerstone in the therapy of opiate and opioid addiction. Among injecting drug users (IDU), individuals infected with Human Immunodeficiency Virus (HIV) constitute a vulnerable population. Despite the use of highly active antiretroviraltreatment (HAART) in IDUs is possible and effective, several factors may adversely affect the treat­ment, including poor adherence to therapy, potential drug interactions between antiretroviral, methadone and illicit drugs, adverse effects and limited and often delayed access to antiretroviral treatment. Drug interactions may potentiate the toxic effects of drugs, reduce the effectiveness of HAART or trigger symptoms of opiate withdrawal, with subsequent relapse in opiate use and lower adherence to care and treatment regimens. The aim of this article is to present a literature’s review about drug interactions between methadone and antiretroviral drugs.

Key Words: Methadone; Drug Interactions; Antiretroviral Drugs; HIV.

 

RESUMEN

]]> La metadona constituye, desde 1956, una alternativa inevitable en el tratamiento de la dependencia de opiáceos. Entre los utilizadores de drogas inyectables (UDI), los sujetos infectados por el virus de la inmunodeficiencia humana (VIH) constituyen una población particularmente vulnerable. A pesar de que su utilización de anti-retrovirales en UDI fuera posible y eficaz, varios factores podrían afectar negativamente el tratamiento, por ejemplo la flaca adhesión a la terapéutica, las potenciales interacciones medica­mentosas entre anti-retrovirales, sustituto opiáceo y drogas ilícitas, los efectos adversos y el acceso limitado y frecuentemente atrasado a los agentes anti-retrovirales. Por otro lado, el tratamiento de la dependencia de opiáceos está asociado a una disminución de los comportamientos de riesgo relacionados con el VIH. Las interacciones medicamentosas entre la metadona y los anti-retrovirales pueden potenciar los efectos tóxicos de los fármacos, disminuir la eficacia de los anti-retrovirales o causar síntomas de privación opiácea, con una consecuente recaída en el consumo de sustancias ilícitas y abandono de la terapéutica. Puesto la actualidad del tema, los autores se propusieran hacer una revisión de la literatura en lo que respecta a las interacciones medicamentosas entre la metadona y los anti-retrovirales y su abordaje en la práctica clínica.

Palabras Clave: Metadona; Interacciones Medicamentosas; Anti-Retrovirales; VIH.

 

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CONTACTOS:

SARA CRISTINA MONTEIRO GONÇALVES DE OLIVEIRA

Interna Formação Específica de Psiquiatria Centro Hospitalar de Vila Nova de Gaia/Espinho. Rua Conceição Fernandes 4434-502 Vila Nova de Gaia.967382533. saramgo@gmail.com

]]> JOSÉ ANTÓNIO LIMA MONTEIRO

Médico Psiquiatra Centro Hospitalar de Vila Nova de Gaia/Espinho.

ÂNGELA MARINA CHAVES VENÂNCIO ALVES

Médica Psiquiatra Centro Hospitalar de Vila Nova de Gaia/Espinho.

JOSÉ CARLOS SILVA TORRES FREIXO

Médico Psiquiatra IDT – DRN – CRI de Braga / ET de Braga Rua Conselheiro Januário, 152 4700 Braga 253008690

 

Artigo recebido em 17/08/10; versão final aceite em 16/10/10.

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