Levomethadyl (levo-alpha-acetylmethadol, LAAM)

Levomethadyl Brand Name– Orlaam

What is Levomethadyl

NOTE: This product has been discontinued in the U.S.

Levomethadyl (levo-alpha-acetylmethadol, LAAM) is a synthetic opiate agonist that has been studied for the management of opiate agonist dependence since the mid-1970’s. Even though levomethadyl is an opiate analgesic, it is not used in pain management.

Levomethadyl is longer-acting than methadone; therefore, it may be given less frequently resulting in fewer clinic visits for patients.

However, due to the potential for QT prolongation and serious cardiac arrhythmias during levomethadyl treatment, the drug was recommended for use only in patients who do not tolerate or respond to methadone therapy.

Levomethadyl has been shown to be as effective as high-dose methadone therapy in reducing illicit use of opioids; studies confirmed the importance of using an adequate dose of medication when treating opiate dependence.

Only treatment programs approved by the FDA, the DEA, and the designated state authority are authorized to dispense levomethadyl. The FDA approved levomethadyl on July 9, 1993; the manufacturer removed the product from marketing in August 2003.

Decreasing sales, reports of severe cardiac-related side effects including QT prolongation, torsades de pointes and cardiac arrest, and the availability of other options for the management of opiate dependance were cited as reasons for the discontinuation of the product.

Indications

• opiate agonist dependence

For the management of opiate agonist dependence in patients who fail to show an acceptable response to other adequate treatments for opiate addiction (e.g., insufficient effectiveness or intolerable side effects)

NOTE: Levomethadyl is only used for the treatment of addiction and is only dispensed by treatment programs approved by the FDA, DEA, and the designated state authority.

Side Effects

1. abdominal pain
2. angina
3. anxiety
4. arthralgia
5. asthenia
6. back pain
7. blurred vision
8. chills
9. constipation
10. cough
11. depression
12. diaphoresis
13. diarrhea
14. dizziness
15. drowsiness
16. edema
17. euphoria
18. headache
19. hot flashes
20. hypotension
21. impaired cognition
22. impotence (erectile dysfunction)
23. insomnia
24. libido decrease
25. malaise
26. miosis
27. myocardial infarction
28. nausea
29. physiological dependence
30. psychological dependence
31. QT prolongation
32. rash
33. respiratory depression
34. rhinitis
35. tolerance
36. torsade de pointes
37. ventricular tachycardia
38. vomiting
39. withdrawal
40. xerostomia
41. yawning

Monitoring Parameters

• ECG

Contraindications

• abrupt discontinuation
• alcoholism
• anxiety
• asthma
• biliary tract disease
• bladder obstruction
• bradycardia
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• children
• chronic obstructive pulmonary disease (COPD)
• constipation
• dental work
• diarrhea
• driving or operating machinery
• electrolyte imbalance
• geriatric
• GI disease
• GI obstruction
• head trauma
• heart failure
• hepatic disease
• hypokalemia
• hypomagnesemia
• hypoxemia
• ileus
• increased intracranial pressure
• infants
• inflammatory bowel disease
• labor
• neonates
• obstetric delivery
• oliguria
• opiate agonist hypersensitivity
• opioid-naive patients
• pain
• pregnancy
• prostatic hypertrophy
• pulmonary disease
• QT prolongation
• renal disease
• renal failure
• renal impairment
• respiratory depression
• seizure disorder
• seizures
• substance abuse
• surgery
• torsade de pointes
• ulcerative colitis
• urethral stricture
• urinary retention

Interactions

• Abarelix
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Diphenhydramine
• Acetaminophen; Pentazocine
• Acetazolamide
• Aclidinium; Formoterol
• Acrivastine; Pseudoephedrine
• Albuterol
• Albuterol; Ipratropium
• Alfuzosin
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alprazolam
• Amide local anesthetics
• Amiloride; Hydrochlorothiazide, HCTZ
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphotericin B
• Amphotericin B cholesteryl sulfate complex (ABCD)
• Amphotericin B lipid complex (ABLC)
• Amphotericin B liposomal (LAmB)
• Amprenavir
• Anxiolytics; Sedatives; and Hypnotics
• Apomorphine
• Aprepitant, Fosaprepitant
• Arformoterol
• Arsenic Trioxide
• Articaine; Epinephrine
• Atazanavir
• Atazanavir; Cobicistat
• Atenolol; Chlorthalidone
• Azelastine
• Azelastine; Fluticasone
• Azilsartan; Chlorthalidone
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Benzodiazepines
• Bepridil
• Beta-agonists
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bosentan
• Brompheniramine
• Brompheniramine; Carbetapentane; Phenylephrine
• Brompheniramine; Dextromethorphan; Guaifenesin
• Brompheniramine; Dextromethorphan; Phenylephrine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Brompheniramine; Pseudoephedrine
• Budesonide; Formoterol
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion; Naltrexone
• Buspirone
• Butorphanol
• Candesartan; Hydrochlorothiazide, HCTZ
• Captopril; Hydrochlorothiazide, HCTZ
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pyrilamine
• Carbinoxamine
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Chlophedianol; Dexbrompheniramine
• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlorcyclizine
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chlorothiazide
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Chlorpromazine
• Chlorthalidone
• Chlorthalidone; Clonidine
• Cimetidine
• Ciprofloxacin
• Cisapride
• Citalopram
• Clarithromycin
• Class IA Antiarrhythmics
• Clemastine
• Clomipramine
• Clonazepam
• Clopidogrel
• Clorazepate
• Clozapine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Conivaptan
• Corticosteroids
• Cyclizine
• Cyproheptadine
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Desipramine
• Dexchlorpheniramine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Promethazine
• Dextromethorphan; Quinidine
• Diazepam
• Dimenhydrinate
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disopyramide
• Dolasetron
• Dolutegravir; Rilpivirine
• Doxepin
• Doxylamine
• Doxylamine; Pyridoxine
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Enalapril; Hydrochlorothiazide, HCTZ
• Enflurane
• Eprosartan; Hydrochlorothiazide, HCTZ
• Erythromycin
• Erythromycin; Sulfisoxazole
• Escitalopram
• Estazolam
• Ethanol
• Ethotoin
• Etomidate
• Ezogabine
• Flecainide
• Fluconazole
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluphenazine
• Flurazepam
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvoxamine
• Formoterol
• Formoterol; Mometasone
• Fosamprenavir
• Foscarnet
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Gallium Ga 68 Dotatate
• Gemifloxacin
• Glycopyrrolate; Formoterol
• grapefruit juice
• Halofantrine
• Haloperidol
• Halothane
• Hydantoins
• Hydralazine; Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydroxyzine
• Iloperidone
• Imatinib
• Imipramine
• Indacaterol
• Indacaterol; Glycopyrrolate
• Indapamide
• Indinavir
• Isoflurane
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Ketamine
• Ketoconazole
• Levalbuterol
• Levobupivacaine
• Lidocaine
• Lidocaine; Prilocaine
• Lomefloxacin
• Loop diuretics
• Lopinavir; Ritonavir
• Lorazepam
• Mannitol
• Maprotiline
• Meclizine
• Mefloquine
• Meperidine; Promethazine
• Mepivacaine
• Mepivacaine; Levonordefrin
• Mesoridazine
• Metaproterenol
• Methazolamide
• Methyclothiazide
• Metolazone
• Midazolam
• Mifepristone
• Mirtazapine
• Monoamine oxidase inhibitors
• Moxifloxacin
• Nalbuphine
• Naloxone
• Naltrexone
• Nefazodone
• Nelfinavir
• Nevirapine
• Norfloxacin
• Nortriptyline
• Ofloxacin
• Olanzapine
• Olodaterol
• Ombitasvir; Paritaprevir; Ritonavir
• Omeprazole; Amoxicillin; Rifabutin
• Ondansetron
• Oxazepam
• Paliperidone
• Pazopanib
• Pentamidine
• Pentazocine
• Pentazocine; Naloxone
• Perphenazine
• Perphenazine; Amitriptyline
• Phenothiazines
• Phenylephrine; Promethazine
• Phenytoin
• Pimozide
• Pirbuterol
• Pramipexole
• Prilocaine
• Prilocaine; Epinephrine
• Procainamide
• Procarbazine
• Prochlorperazine
• Promethazine
• Propafenone
• Protriptyline
• Quazepam
• Quetiapine
• Quinidine
• Ranolazine
• Rifabutin
• Rifampin
• Rifamycins
• Rifapentine
• Rilpivirine
• Risperidone
• Ritonavir
• Ropivacaine
• Salmeterol
• Sedating H1-blockers
• Sevoflurane
• Sparfloxacin
• St. John’s Wort, Hypericum perforatum
• Tacrolimus
• Telithromycin
• Temazepam
• Terbutaline
• Terfenadine
• Thiazide diuretics
• Thiethylperazine
• Thioridazine
• Tiotropium; Olodaterol
• Tipranavir
• Trandolapril; Verapamil
• Triazolam
• Tricyclic antidepressants
• Trifluoperazine
• Trimipramine
• Triprolidine
• Umeclidinium; Vilanterol
• Vardenafil
• Verapamil
• Voriconazole
• Vorinostat
• Zafirlukast
• Zileuton
• Ziprasidone