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Heroin Addiction and Related Clinical Problems: 2021, 23, N4 (pages: 33 - 41)

Effectiveness, tolerability and safety of a long-term therapy with levomethadone in clinical practice: a retrospective observational study

Consoli A.

Summary: Background: Methadone is the gold standard for the treatment of opioid withdrawal syndrome and in maintenance therapy of opioid addiction. Literature evidence demonstrated that most of the pharmacological effect of methadone is attributed to its left-handed enantiomer, levomethadone. Since 2015, use of pure levomethadone has been approved in Italy. Aim: The aim of the present retrospective observational study is to investigate the effectiveness and the tolerability of a long-term treatment with levomethadone, in adults formerly treated with racemic methadone or other pure and/or partial opioid agonists or in drug-naïve subjects. Methods: Patients treated with levomethadone at the Valdera Drug Addiction Unit (SerD) for at least 6 months, between 1 June 2016 and 30 April 2018, were included. Levomethadone dosages, retention in treatment, craving, positivity to toxicological tests for opiate during therapy have been evaluated. Tolerability and safety evaluations were considered as secondary outcome. Results: In total, 18 patients were observed (15 previously treated, 3 drug-naïve). The mean dosage of levomethadone for previously treated patients was slightly higher than 50% of the mean dosage of racemic methadone used previously. Reduction of craving and a progressive reduction of positivity for opioids in toxicological examinations were observed. Data relating to safety show a favorable risk/benefit ratio. No adverse events were reported. Conclusions: Levomethadone treatment administered for a long-term period is safe and well tolerated, is effective in the resolution of withdrawal syndrome and in the treatment of disease, with high retention to treatment, reduction in craving and opioid use.