PCSS-MOUD On-Demand Webinar: Methadone and Buprenorphine-Associated Drug-Drug Interactions-Presentation

Video Transcription

Video Summary

This webinar, led by Dr. Thaddeus Ihinyacho, focused on clinically relevant drug-drug interactions involving methadone and buprenorphine in opioid use disorder treatment. He explained why these interactions matter, especially given the ongoing opioid overdose crisis and rising deaths from synthetic opioids like fentanyl.<br /><br />Key points included the difference between pharmacokinetic interactions, where the body affects the drug, and pharmacodynamic interactions, where drugs have combined effects on the body. Methadone is more vulnerable to interactions because it is metabolized by CYP liver enzymes and can also prolong the QT interval, raising cardiac risk. Common interacting drugs include benzodiazepines, certain antidepressants, rifampicin, anticonvulsants, alcohol, and some antiretrovirals. Buprenorphine was presented as generally safer, with fewer major interactions, strong receptor binding, partial agonist activity, and less QT prolongation risk.<br /><br />Dr. Ihinyacho emphasized practical risk-reduction strategies: medication reconciliation, care coordination, clear patient education, avoiding unnecessary polypharmacy, and choosing safer alternatives when possible. He stressed that co-prescribing opioids and benzodiazepines increases overdose risk and that patients should be counseled not to share medications or take extra doses on their own.

Keywords

methadone

buprenorphine

drug-drug interactions

opioid use disorder

pharmacokinetic interactions

pharmacodynamic interactions

QT prolongation

benzodiazepines

overdose risk