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Influence of metabolic processes on course and treatment of opioid-dependence
Present evidence suggests that therapeutic drug monitoring and pharmacogenetic tests are useful tools in the treatment of opioid-dependence by methadone. The role of cytochrome P-450 in its stereoselective metabolism has been investigated in pharmacogenetic and interaction studies (1, 2). Moreover, clinical studies support the use of therapeutic drug monitoring of R-methadone rather than R,S-methadone in patients treated with racemic methadone.
1. C. B. Eap, T. Buclin, and P. Baumann. Interindividual variability of the clinical pharmacokinetics of methadone: implications for the treatment of opioid dependence. Clin.Pharmacokinet. 41 (14):1153–1193, 2002.
2. C. B. Eap, F. Broly, A. Mino, R. Hämmig, J. J. Deglon, C. Uehlinger, D. Meili, A. F. Chevalley, G. Bertschy, D. Zullino, M. Kosel, M. Preisig, and P. Baumann. Cytochrome P450 2D6 genotype and methadone steady-state concentrations. J.Clin.Psychopharmacol. 21 (2):229–234, 2001.
3. C. B. Eap, M. Bourquin, J.-L. Martin, J. Spagnoli, S. Livoti, K. Powell, P. Baumann, and J.-J. Déglon. Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment. Drug Alcohol Depend. 61:47–54, 2000