Pharmacopsychiatry 2024; 57(02): 88
DOI: 10.1055/s-0044-1779564
Abstracts │ XVth Symposium of the Task Force Therapeutic Drug Monitoring of the AGNP
Lecture Abstracts

Therapeutic Drug Monitoring as part of the Opioid Withdrawal Therapy

P. Pfeifer
1   University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
› Author Affiliations
 

Therapeutic drug monitoring (TDM) is recommended for opioid maintenance therapy with levomethadone. However, there are not much data available regarding use of TDM to monitor opioid withdrawal therapy clinically although optimization tools are required.

In this observational cohort study, regular TDM with levomethadone was performed according to a prospective opioid withdrawal protocol. Objective and subjective opioid withdrawal symptoms were measured using validated rating scales and correlations to levomethadone serum concentrations were assessed.

Plasma levels were measured using high-pressure liquid chromatography with column switching and spectroscopic detection of methadone and its major metabolite.

This study included 31 patients with opioid-dependence. The serum levels of levomethadone were found to be highly variable and below the recommended therapeutic reference range of 250 ng/mL for maintenance therapy. These serum levels were positively correlated with dosage (r = 0.632; P , 0.001) and inversely correlated with subjective (r = 20.29; P = 0.011) and objective (r = 20.28; P = 0.014) withdrawal symptoms.

The evidence provided sheds light on how to improve levomethadone withdrawal therapy in patients with opioid dependence. It seems that higher initial doses at the beginning and lower dose reductions would have been advantageous. TDM can enhance the safety of opioid withdrawal therapies, minimize withdrawal symptoms, and reduce dropout rates.



Publication History

Article published online:
12 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany