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Heroin Addiction and Related Clinical Problems: 2022, 24, N6 (pages: 25 - 32)

New insights from Observational Retrospective Study on Tolerability of Levomethadone in Patients with Opioid Use Disorder

Sacco S., Barciocco D., Mussi D., and Bartoletti L.

Summary: Background: Methadone, a racemic mixture of 2 enantiomers, is the gold standard for treating opioid withdrawal syndrome and in the maintenance therapy of opioid addiction. Anyway, the risk of cardiac events, individual variability, and metabolic interferences with other drugs pose a therapeutic challenge in some patients with the need to choose different therapeutic approaches in daily clinical practice. Levomethadone, the laevorotatory enantiomer, can be used at 50% of the racemic preparation with the same therapeutic efficacy. Anyway, data from daily clinical practice are needed regarding the tolerability grade compared to methadone. Methods: A single-centre retrospective observation was conducted on 58 patients with Opioid use disorder (OUD) in agonist maintenance therapy with levomethadone over two months to assess tolerability in terms of drug symptoms and patient quality of life. Results: After two months of treatment, levomethadone does not need a significant adjustment dose, demonstrating the therapeutic equivalence of racemic methadone and levomethadone at a 2:1 ratio. VAS results revealed a decrease of symptoms related to the presence of constipation, sweating, sedation, sexual dysfunction, and changes in the mood tone, both in the drug naïve subjects and patients previously treated with racemic methadone. In particular, for methadone/buprenorphine subjects, constipation and sweating symptoms decrease in a significant manner (p<0.05). PGIC results reveal a reasonable satisfaction of the patients, especially in HIV patients. Results confirmed the tolerability and satisfaction of OUD patients switching from racemic to levomethadone, pointing out the benefits of levomethadone, especially in patients with comorbidity or in polytherapy. In the case of initial treatment, the drug naïve patient's data reveal that levomethadone is well tolerated, and no adverse effects are reported. Conclusions: Levomethadone is a safe option over methadone, especially for dedicated subgroups of patients.