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Induction with levomethadyl acetate: safety and efficacy
H E Jones1, E C Strain, G E Bigelow
1Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21224-6823, USA.
Archives of General Psychiatry
|August 26, 1998
Summary
Levomethadyl acetate hydrochloride (LAAM) induction can be safely achieved within 7 days with low to medium doses. Higher LAAM doses require a slower 17-day induction to minimize adverse effects and potential dropout.
Area of Science:
- Pharmacology
- Addiction Medicine
- Clinical Trials
Background:
- Levomethadyl acetate hydrochloride (LAAM) is an approved mu-opioid agonist for opioid dependence treatment.
- Previous studies suggest lower retention rates with LAAM compared to methadone, potentially due to dosing differences.
- Systematic examination of LAAM induction dosing is limited.
Purpose of the Study:
- To compare the safety and efficacy of three different Levomethadyl acetate hydrochloride (LAAM) induction dosage levels.
- To evaluate the impact of varying LAAM induction schedules on patient outcomes.
Main Methods:
- A randomized, double-blind trial involving 180 opioid-dependent patients.
- Three LAAM induction groups: low-dose (25 mg constant), medium-dose (50 mg over 7 days), and high-dose (100 mg over 17 days).
- Assessment of safety and efficacy through retention rates, urinalysis, self-reported drug use, symptoms, and medication adequacy.
Main Results:
- The high-dose LAAM group showed significantly fewer illicit opioid-positive urines and lower self-reported heroin craving in early weeks.
- All groups achieved significant reductions in illicit drug use, withdrawal, and depression.
- No significant differences in retention, but a trend towards lower retention and more adverse effects in the high-dose group.
Conclusions:
- Low and medium LAAM doses can be safely and effectively induced within 7 days.
- Higher LAAM doses can be safely induced over 17 days, but may increase dropout and adverse effects.
- Slower induction is recommended for higher LAAM doses to improve patient tolerance and retention.