Pharmacopsychiatry 2020; 53(03): 139
DOI: 10.1055/s-0040-1710110
Abstracts
XIVth Symposium of the Task Force Therapeutic Drug Monitoring of the AGNP

2 Drug interactions in patients undergoing opioid maintenance therapy

I Adamovic
1   Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Germany
,
C Vierke
1   Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Germany
,
M Boettcher
3   MVZ Dessau Laboratory GmbH, Dessau, Germany
,
C Hiemke
4   Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
,
U Havemann-Reinecke
1   Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Germany
2   DFG Research Center of Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), Göttingen, Germany
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    Introduction Patients undergoing opioid maintenance therapy (OMT) have a high rate of additional consumption of cannabis and of somatic (especially hepatitis virus infections) and psychiatric comorbidities. Cannabis interferes with Cytochrome P 450 (CYP) isoenzymes and seems to be a potential inhibitor of CYP3A4 and by this may lead to drug-drug interactions. Buprenorphine (BUB), a partial μ-opioid agonist widely used for opioid maintenance therapy (OMT) is mainly metabolized to pharmacologically active norbuprenorphine by CYP3A4. We present OMT patient data of cannabis use on BUP plasma levels with and without psychiatric comedication duloxetine, trazodone.

    Methods 1. Retrospective analysis of clinical symptoms and of BUP and nor-BUP plasma levels in liver healthy OMT patients substituted with BUP, either with (n = 15) or without (n = 17) concomitant use of cannabis. 2. Analysis of BUPs and antidepressive drug plasma levels of a female OMT patient in various stages of hepatitis virus disease and with and without cannabis use.

    Results 1. Cannabis users and non-users received similar doses, but users had 2.7-fold higher concentrations of BUP (p < 0.01) and 1.4-fold for nor-BUP(1.4-fold, p = 0.07). The metabolite-to-parent drug ratio was 0.98 in non-users and 0.38 in users (p = 0.02) with no significant effect of gender. 2. During cannabis abstinence a higher plasma level of duloxetine and trazodone could be found.

    Conclusion Cannabis use decreases the formation of nor-BUP and elevates BUP and nor-BUP concentrations and lowers blood plasma levels of duloxetine and trazodone most probably by inhibition of CYP3A4. TDM can detect interaction effects by comedication and/or coconsumption of drugs.


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    Artikel online veröffentlicht:
    30. April 2020

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