Tetrault Jeanette M, McCance-Katz Elinore F, Moody David E, Fiellin David A, Lruie Bonnie S, DInh An T, Fiellin Lynn E
Department of Internal Medicine. Yale University School of Medicine, New Haven, CT, USA.
Substance Abuse and Mental Health Services Administration, Rockville, MD, USA.
J Subst Abuse Treat. 2015 Apr;51:70-4. doi: 10.1016/j.jsat.2014.10.010. Epub 2014 Nov 5.
Cocaine decreases methadone and buprenorphine plasma concentrations. HIV infection and/or antiretroviral medication use may impact these relationships. We sought to determine the association between recent cocaine use and methadone and buprenorphine concentrations in HIV-infected and uninfected subjects in clinical care. R- and S-methadone or buprenorphine and norbuprenorphine concentrations were assessed at 0.5, 1, 2, and 24 hours after dosing in subjects with confirmed cocaine use and abstinence. We compared methadone and buprenorphine concentrations for cocaine use vs. abstinence, by HIV status in 16 subjects receiving methadone (6 HIV-infected) and 17 receiving buprenorphine (8 HIV-infected). With recent cocaine use, peak R-methadone (244 vs. 297 ng/mL, p = 0.03) and peak S-methadone (285 vs. 339 ng/mL); p = 0.03 concentrations were lower in HIV-uninfected subjects only. Peak buprenorphine and norbuprenorphine concentrations were unchanged regardless of cocaine use or HIV status. Cocaine may decrease methadone concentrations in HIV-uninfected subjects. HIV infection or its treatment may attenuate cocaine's effect on methadone.
可卡因会降低美沙酮和丁丙诺啡的血浆浓度。HIV感染和/或抗逆转录病毒药物的使用可能会影响这些关系。我们试图确定在临床护理中，近期使用可卡因与HIV感染和未感染受试者体内美沙酮及丁丙诺啡浓度之间的关联。在已证实使用可卡因和戒毒的受试者中，于给药后0.5、1、2和24小时评估R-美沙酮、S-美沙酮或丁丙诺啡及去甲丁丙诺啡的浓度。我们比较了16名接受美沙酮治疗的受试者（6名HIV感染者）和17名接受丁丙诺啡治疗的受试者（8名HIV感染者）中，按HIV状态划分的使用可卡因与戒毒情况下美沙酮和丁丙诺啡的浓度。近期使用可卡因时，仅在未感染HIV的受试者中，R-美沙酮峰值（244 vs. 297 ng/mL，p = 0.03）和S-美沙酮峰值（285 vs. 339 ng/mL；p = 0.03）较低。无论是否使用可卡因或HIV状态如何，丁丙诺啡和去甲丁丙诺啡的峰值浓度均无变化。可卡因可能会降低未感染HIV受试者体内的美沙酮浓度。HIV感染或其治疗可能会减弱可卡因对美沙酮的作用。
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