Opioids

Question 1

Potential interactions with methadone

Answer 1

Benzodiazepine (respiratory depression).

Should not be used with suboxone or naltrexone.

Haloperidol, ziprasidone, pimozide (QT)

Carbamazapine (inducer)

Fluoxetine, fluvoxamine, tramadol

Question 2

Ingredients of Suboxone

Answer 2

Buprenorphine and naloxone

Question 3

Dosing of buprenorphine.

Answer 3

Initial 2-4 mg, max 8 mg on the first day. Titrate dose to prevent withdrawal symptoms.

Question 4

Maximum dose of Suboxone

Answer 4

24 mg daily

Question 5

Condition that must be present to start Suboxone

Answer 5

Patient must be in opioid withdrawal already otherwise withdrawal will be precipitated.

Question 6

Dose titration of methadone

Answer 6

Initial dose of 30 mg. Titrated usually to 80-120 mg / day. Rare to exceed 120 mg.

Question 7

Screening question for drug dependence

Answer 7

How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons? (3 or more in the past year is predictive of drug dependence).

Question 8

Outcomes of abstinence-based treatment

Answer 8

Poor; about 10% at one year.

Question 9

Suboxone compared to methadone

Answer 9

Evidence is more favourable for methadone, but suboxone is easier to use.

Question 10

Effects of methadone on the heart

Answer 10

Increases QT interval

Question 11

These medications are relatively safe to use with methadone

Answer 11

Sertraline, venlafaxine, mirtazapine, bupropion, valproic acid.