Fluvoxamine as an adjunct to promote methadone dose optimization
In order for methadone maintenance treatment to be effective, an adequate methadone serum level (MSL) must be attained. A number of factors can affect MSL, especially drugs that interact with the hepatic cytochrome P450 enzyme system. We report here 3 cases of patients who had difficulty stabilizing on methadone with continued complaints of opiate withdrawal symptoms, drug cravings, and continued opiate positive urine drug screens despite a methadone dose of 100 mg. Each had either low MSL or a high peak to trough MSL ratio (P/T ratio). Fluvoxamine, a selective serotonin reuptake inhibitor with potent cytochrome P450 enzyme inhibitory properties, was administered to each of the patients resulting in significant increases in MSL or a decrease in P/T ratio and leading to improvement in clinical status including cessation of opiate use. The mechanism and potential therapeutic role, as well as precautions, are discussed. Copyright © 2003 Lippincott Williams & Wilkins, Inc.
DeMaria, PA; Patkar, AA; Vassos, K
Volume / Issue
Start / End Page
International Standard Serial Number (ISSN)
Digital Object Identifier (DOI)