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Vol. 26, Issue 3, 257-260, March 1998

Inhibition of Methadone and Buprenorphine N-Dealkylations by Three HIV-1 Protease Inhibitors

Christelle Iribarne, François Berthou, Dominique Carlhant, Yvonne Dreano, Daniel Picart, Françoise Lohezic, and Christian Riche

Laboratoires de Biochimie-Nutrition EA948 (C.I., F.B., Y.D., D.P.) and Laboratoire de Pharmacologie, Faculté de Médecine (D.C., F.L., C.R.)

Ritonavir, indinavir, and saquinavir, all human immunodeficiency virus-1 protease inhibitors with a potent antiviral effect during triple therapy, are extensively metabolized by liver cytochrome P450 3A4. As this P450 isoform is involved in the metabolism of about 50% of drugs, coadministration of protease inhibitors with other drugs may lead to serious effects due to enzyme inhibition. Among these drugs, methadone and buprenorphine, both metabolized by P450 3A4, are potential candidates to drug interactions. In this study, metabolic interactions between these protease inhibitors and methadone or buprenorphine were studied in vitro in a panel of 13 human liver microsomes. Ritonavir was the most potent competitive inhibitor with Ki about 50 and 20 nM for methadone and buprenorphine metabolisms, respectively. Indinavir and saquinavir also inhibited methadone N-demethylation (Ki about 3 and 15 µM, respectively) and buprenorphine N-dealkylation (Ki about 0.8 and 7 µM, respectively). The rank order of inhibition potency against metabolism of methadone and buprenorphine was ritonavir > indinavir > saquinavir. There is obvious potential for clinically significant drug interactions, particularly with ritonavir. In brief, caution should be advised if human immunodeficiency virus-1 protease inhibitors are coadministered with methadone and buprenorphine.

Copyright © 1998 by The American Society for Pharmacology and Experimental Therapeutics


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