Question

28 yr old on methadone maintenance therapy develops worsening anxiety and flu-like symptoms since switched from valproate to carbamazepine for seizure control 2 weeks ago. What should be the next step in management?

Answer 1

The next step in management would be to evaluate the possibility of a drug interaction and consider adjusting the dose of methadone or switching to an alternate anticonvulsant.

Step-by-step explanation:

The worsening anxiety and flu-like symptoms in a 28-year-old on methadone maintenance therapy who recently switched from valproate to carbamazepine may indicate a **withdrawal syndrome**. This could be due to an interaction between carbamazepine and methadone, as carbamazepine is known to decrease the blood levels of methadone. The **next step in management** would be to evaluate the possibility of a drug interaction and consider adjusting the dose of methadone or switching to an alternate anticonvulsant.