Pharmacopsychiatry 2003; 36 - 59
DOI: 10.1055/s-2003-825310

Influence of metabolic processes on course and treatment of opioid-dependence

CB Eap 1, P Baumann 1
  • 1Unité de Biochimie et Psychopharmacologie Clinique, Univ. Dept of Adult Psychiatry, Center of Psychiatric Neurosciences, Prilly, Switzerland

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