AZOLES AND OPIOIDS - METHADONE

Fluconazole may increase the levels and AUC of methadone by about 30%; a single case reports opioid toxicity. Ketoconazole and voriconazole appear to interact with methadone to a greater extent (methadone levels raised by 50% or more).
Patients given these azoles with methadone should be monitored for signs of opioid toxicity and a methadone dose alteration should be considered. However, note that the interaction with fluconazole is considered unlikely to be of general clinical significance.
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