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*(Levo-) Methadon (Stoffgruppe: Opioid-Analgetikum)

Vor dem Einsatz von (Levo-)Methadon zur Behandlung starker Schmerzen sollte man sich gut mit dessen Pharmakologie und Pharmakokinetik auseinandersetzen. (Levo-)Methadon sollte Patienten, die nicht gut auf Morphin oder andere m-Opioid-Rezeptor-Agonisten ansprechen, vorbehalten sein. Die wichtigsten Fakten dieses Arzneistoffes umfassen:

- sehr variable Plasmahalbwertzeit

- weitaus kompliziertere Dosierung als bei anderen starken Opioiden

- klinisch relevante Veränderungen des Metabolismus durch andere palliativmedizinisch relevante Arzneistoffe

- Zusammenhang mit möglicherweise tödlich verlaufenden Herzrhythmusstörungen (siehe unter Warnhinweise und unter Verlängerung der QT-Zeit in der Palliativmedizin)

- Hinzukommt, dass Methadon aufgrund des Einsatzes in der Substitutionsbehandlung Drogenabhängiger ein soziales Stigma anhaftet. (palliativedrugs.com, Anmeldung nötig, zuletzt aufgerufen 14.04.2018)

https://www.palliativedrugs.com/formulary/de/levo-methadon.html

Methadone Concentrations in Exhaled Breath Condensate, Serum and Urine of Patients Under Maintenance Treatment.

Khoubnasabjafari M, Ansarin K, Jouyban-Gharamaleki V, Panahi-Azar V, Hamidi S, Azarmir Z, Jouyban A.

Iran J Pharm Res. 2017 Fall;16(4):1621-1630.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843324/

The Impact of Enrolment in Methadone Maintenance Therapy on Initiation of Heavy Drinking among People Who Use Heroin.

Klimas J, Wood E, Nguyen P, Dong H, Milloy MJ, Kerr T, Hayashi K.

Eur Addict Res. 2016;22(4):210-4. doi: 10.1159/000444513.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862898/

Methadone treatment, severe food insecurity, and HIV-HCV co-infection: A propensity score matching analysis.

McLinden T, Moodie EEM, Hamelin AM, Harper S, Rossi C, Walmsley SL, Rourke SB, Cooper C, Klein MB, Cox J.

Drug Alcohol Depend. 2018 Feb 20;185:374-380. doi: 10.1016/j.drugalcdep.2017.12.031.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/29544189

Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial.

Hser YI, Evans E, Huang D, Weiss R, Saxon A, Carroll KM, Woody G, Liu D, Wakim P, Matthews AG, Hatch-Maillette M, Jelstrom E, Wiest K, McLaughlin P, Ling W.

Addiction. 2016 Apr;111(4):695-705. doi: 10.1111/add.13238.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4801718/

Practical Pharmacology of Methadone: A Long-acting Opioid.

Sunilkumar MM, Lockman K.

Indian J Palliat Care. 2018 Jan;24(Suppl 1):S10-S14. doi: 10.4103/IJPC.IJPC_180_17. Review.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806300/

Emergence of methadone as a street drug in St. Petersburg, Russia.

Heimer R, Lyubimova A, Barbour R, Levina OS.

Int J Drug Policy. 2016 Jan;27:97-104. doi: 10.1016/j.drugpo.2015.10.001.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4715906/

Umstellung von Methadon / Polamidon auf Buprenorphin – die Ravensburger Strategie

Dr.med. Frank Matschinski; SchwerPunktPraxis Ravensburg, 2013

https://www.forum-substitutionspraxis.de/images/Download/PDF/Umstellung_von_Methadon___Polamidon_auf_Buprenorphin__die_Ravensburger_Strategie.pdf

Sexual Dysfunction in Heroin Dependents: A Comparison between Methadone and Buprenorphine Maintenance Treatment.

Yee A, Danaee M, Loh HS, Sulaiman AH, Ng CG (2016)

PLoS ONE 11(1): e0147852. doi.org/10.1371/journal.pone.0147852

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147852

Respiratory Variability during Sleep in Methadone Maintenance Treatment Patients.

Nguyen CD, Kim JW, Grunstein RR, Thamrin C, Wang D.

J Clin Sleep Med. 2016 Apr 15;12(4):607-16. doi: 10.5664/jcsm.5702.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795289/

Patterns of non-compliant buprenorphine, levomethadone, and methadone use among opioid dependent persons in treatment.

Casati A, Piontek D, Pfeiffer-Gerschel T.

Subst Abuse Treat Prev Policy. 2014 May 21;9:19. doi: 10.1186/1747-597X-9-19.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035758/

Distribution of Methadone and Metabolites in Skeletal Tissue.

Vandenbosch M, Somers T, Cuypers E.

J Anal Toxicol. 2018 Feb 27. doi: 10.1093/jat/bky014.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/29490025

Methadone and levomethadone - dosage and side effects.

Schoofs N, Riemer T, Bald LK, Heinz A, Gallinat J, Bermpohl F, Gutwinski S.

Psychiatr Prax. 2014 Mar;41(2):82-7. doi: 10.1055/s-0033-1349627. Epub 2013 Nov 19. German.

Abstract

https://www.thieme-connect.com/DOI/DOI?10.1055/s-0033-1349627

Methadone Dose Adjustments, Plasma R-Methadone Levels and Therapeutic Outcome of Heroin Users: A Randomized Clinical Trial.

Mannaioni G, Lanzi C, Lotti M, Galli V, Totti A, Pacileo I, Sili M, Pracucci C, Dilaghi A, Bertieri L, Quaranta M, Orsini F, Occupati B, Michahelles A, Ciuti R, Bianchini E, Fabbro G, Biggeri A, Masini E, Moroni F.

Eur Addict Res. 2018 Jan 31;24(1):9-18. doi: 10.1159/000485029.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/29393208

The effects of racemic D,L-methadone and L-methadone in substituted patients--a randomized controlled study.

Verthein U, Ullmann R, Lachmann A, Düring A, Koch B, Meyer-Thompson HG, Schmidt R, Reimer J, Haasen C.

Drug Alcohol Depend. 2005 Nov 1;80(2):267-71.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/15916866

Effects of Cytochrome P450 Single Nucleotide Polymorphisms on Methadone Metabolism and Pharmacodynamics.

Ahmad T, Valentovic MA, Rankin GO.

Biochem Pharmacol. 2018 Feb 16. pii: S0006-2952(18)30077-7. doi: 10.1016/j.bcp.2018.02.020.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/29458047

USA-New York. Opioid Addiction Knows No Color, but its Treatment Does

On a street lined with garbage trucks, in an industrial edge of Brooklyn, dozens of people started filing into an unmarked building before the winter sun rose. Patients gather here every day to visit the Vincent Dole Clinic, where they are promised relief from their cravings and from the constant search for heroin on the streets. (NYT, 12.01.2018)

https://www.nytimes.com/2018/01/12/nyregion/opioid-addiction-knows-no-color-but-its-treatment-does.html

Pharmacogenetics of Methadone Response.

Fonseca F, Torrens M.

Mol Diagn Ther. 2018 Feb;22(1):57-78. doi: 10.1007/s40291-017-0311-y. Review.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/29168075

USA. Buprenorphine and Methadone Dispensing in New York City.

Tuazon E, Kunins H, Paone D.

New York City, Department of Health and Mental Hygiene: Epi Data Brief (96); November 2017.

Buprenorphine and methadone are opioid agonist medications that are both safe and effective in the treatment of opioid use disorders . Methadone dispensing has been available through certified New York State Office of Alcoholism and Substance Abuse Services (OASAS) Opioid Treatment Programs in New York City (NYC) since the late 1970s.

Buprenorphine has been approved for treatment of opioid use disorders since 2002, and is now available by prescription from physicians, nurse practitioners, and physician assistants trained and approved to prescribe it.

In 2016, there were 69 OASAS-certified opioid treatment programs in NYC with a capacity to dispense methadone to approximately 32,000 patients with opioid use disorders.

(...) Most new patients in methadone treatment were Latino and Black or African-American (50% and 20%, respectively). One in three (27%) new patients in methadone treatment were White.

https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief96.pdf

A two-week pilot study of intranasal oxytocin for cocaine-dependent individuals receiving methadone maintenance treatment for opioid use disorder.

Stauffer CS, Musinipally V, Suen A, Lynch KL, Shapiro B, Woolley JD.

Addict Res Theory. 2016;24(6):490-498. doi: 10.3109/16066359.2016.1173682.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424696/

The Evaluation of Relationship between Sexual Self-concept and Sexual Dysfunction in Individuals Undergoing Methadone Maintenance Treatment.

Rajabizadeh G, Yazdanpanah F, Ramezani MA.

Addict Health. 2017 Apr;9(2):88-95.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742415/

Cardiovascular effects of methadone and concomitant use of diazepam during methadone maintenance treatment induction: low concentration risk.

Mijatović V, Samojlik I, Petković S, Vukmirović S, Uvelin A, Dickov A.

Expert Opin Drug Saf. 2017 Dec;16(12):1323-1328. doi: 10.1080/14740338.2017.1382470.

Abstract

https://www.ncbi.nlm.nih.gov/pubmed/28934555

  1. Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients.
  2. Long QTc During Methadone Maintenance: Contributors and Interventions Over 4 Years.
  3. Arrhythmia associated with buprenorphine and methadone reported to the Food and Drug Administration.
  4. Oxytocin protocol appears workable and safe for methadone patients who use cocaine
  5. Buprenorphine as a safe alternative to methadone in a patient with acquired long QT syndrome: a case report.