@article {1419,
	title = {The protease inhibitor lopinavir-ritonavir may produce opiate withdrawal in methadone-maintained patients.},
	journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
	volume = {37},
	year = {2003},
	month = {2003 Aug 15},
	pages = {476-82},
	abstract = {This study examines the pharmacokinetic/pharmacodynamic interactions between (1) lopinavir-ritonavir (L/R), a fixed combination of protease inhibitors used for the treatment of HIV disease, and (2) ritonavir alone at the same dosage as that in the L/R formulation, with methadone, an opiate frequently used in substance abuse pharmacotherapy for opioid (heroin)-dependent injection drug users, many of whom are infected with HIV. L/R was associated with significant reductions in the methadone area under the concentration-time curve (P<.001), maximum concentration (P<.001), and minimum concentration (P<.001), as well as increased methadone oral clearance (P<.001) and increased opiate withdrawal symptoms (P=.013), whereas ritonavir use alone modestly and nonsignificantly increased methadone concentrations. Lopinavir is a potent inducer of methadone metabolism, and treatment with L/R requires clinical monitoring and increased methadone doses in some patients, whereas ritonavir has no significant effect on methadone metabolism.},
	keywords = {HIV Infections, HIV Protease Inhibitors, Humans, Lopinavir, Methadone, Narcotics, Opioid-Related Disorders, Pyrimidinones, Ritonavir, Substance Withdrawal Syndrome},
	issn = {1537-6591},
	author = {McCance-Katz, Elinore F and Rainey, Petrie M and Friedland, Gerald and Jatlow, Peter}
}
