Date of report 20 Jun 2019
Reported case interaction between
Rilpivirine and Methadone
Rilpivirine and Methadone
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Methadone, Sofosbuvir/velpatasvir
Clinical case description
45 year-old HIV/HCV patient. On antiretroviral therapy with raltegravir plus rilpivirine and unboosted atazanavir (GI intolerant to ritonavir and cobicistat; suspected resistance to NRTI -further reviewed and considered to retain activity for TDF/TAF). Concomitat treatment with methadone (165 mg qd). Prolonged QTc in ECG (673 msec). It was considered that rilpivirine, atazanavir and methadone were all potentially contributing to increase QTc. Antiretroviral therapy was changed to Bictegravir/FTC/TAF and methadone dose was decreased to 150 mg qd. A new ECG performed 2 weeks after showed a decrease in QTc to 443 msec.
Clinical Outcome
Drug Interaction Probability Scale (DIPS)
Editorial Comment
ATV and RIL have only slight effect on methadone plasmatic concentrations. However, considering that the three drugs have all shown to have the potential to increase QT interval, prescription of such association (or other drug combination known for sharing the same potential side effect) should be performed with caution. Currently, unboosted atazanavir is rarely prescribed although it could be eventually chosen to build an active ARV regimen when ritonavir or cobicistat need to be avoided.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration