Abstract
Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitor that is an inducer of the cytochrome P-450 enzymes 2D6 and 3A4. There are several reports that it can increase the metabolism of methadone leading to decreased methadone levels and the precipitation of opioid withdrawal in patients previously maintained on a stable methadone dose. There are no reports of its effects on the metabolism of LAAM. A case is presented in which a patient previously on a stable dose of LAAM experienced opioid withdrawal shortly after beginning an anti retroviral regimen that included nevirapine. Nevirapine appears to induce opioid withdrawal in patients previously stable on LAAM. Some potential differences in the time course and management of nevirapine-induced withdrawal from LAAM, as compared to methadone, are discussed.
Key Words: