A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products.

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Stolbach A, Paziana K, Heverling H, Pham P

A Review of the Toxicity of HIV Medications II: Interactions with Drugs and Complementary and Alternative Medicine Products.

J Med Toxicol. 2015 Sep;11(3):326-41. doi: 10.1007/s13181-015-0465-0.

PubMed ID

26036354 [ View in PubMed

]

Abstract

For many patients today, HIV has become a chronic disease. For those patients who have access to and adhere to lifelong antiretroviral (ARV) therapy, the potential for drug-drug interactions has become a real and life-threatening concern. It is known that most ARV drug interactions occur through the cytochrome P450 (CYP) pathway. Medications for comorbid medical conditions, holistic supplements, and illicit drugs can be affected by CYP inhibitors and inducers and have the potential to cause harm and toxicity. Protease inhibitors (PIs) tend to inhibit CYP3A4, while most non-nucleoside reverse transcriptase inhibitors (NNRTIs) tend to induce the enzyme. As such, failure to adjust the dose of co-administered medications, such as statins and steroids, may lead to serious complications including rhabdomyolysis and hypercortisolism, respectively. Similarly, gastric acid blockers can decrease several ARV absorption, and warfarin doses may need to be adjusted to maintain therapeutic concentrations. Illicit drugs such as methylenedioxymethamphetamine (MDMA, "ecstasy") in combination with PIs lead to increased toxicity, while the concomitant administration of sedative drugs such as midazolam and alprazolam in patients taking PIs can result in prolonged sedation, delayed recovery, and increased length of stay. Even supplements like St. John's Wort can alter PI concentrations. In theory, any drug that is metabolized by CYP has potential for a pharmacokinetic drug-drug interaction with all PIs, cobicistat, and most NNRTIs. When adding a new medication to an ARV regimen, use of a drug-drug interaction software and/or consultation with a clinical pharmacist/pharmacologist or HIV specialist is recommended.

DrugBank Data that Cites this Article

Drug Enzymes

Drug	Enzyme	Kind	Organism	Pharmacological Action	Actions
Chlordiazepoxide	Cytochrome P450 3A4	Protein	Humans	Unknown	Substrate	Details
Nevirapine	Cytochrome P450 2C9	Protein	Humans	Unknown	Inducer	Details

Drug Interactions

Drugs	Interaction
Integrate drug-drug interactions in your software
Amiodarone Asunaprevir	The serum concentration of Amiodarone can be increased when it is combined with Asunaprevir.
Amiodarone Indinavir	The serum concentration of Amiodarone can be increased when it is combined with Indinavir.
Amiodarone Amprenavir	The serum concentration of Amiodarone can be increased when it is combined with Amprenavir.
Amiodarone Atazanavir	The serum concentration of Amiodarone can be increased when it is combined with Atazanavir.
Amiodarone Saquinavir	The serum concentration of Amiodarone can be increased when it is combined with Saquinavir.
Amiodarone Lopinavir	The serum concentration of Amiodarone can be increased when it is combined with Lopinavir.
Amiodarone Fosamprenavir	The serum concentration of Amiodarone can be increased when it is combined with Fosamprenavir.
Amiodarone TMC-310911	The serum concentration of Amiodarone can be increased when it is combined with TMC-310911.
Clorazepic acid Saquinavir	The serum concentration of Clorazepic acid can be increased when it is combined with Saquinavir.
Diazepam Saquinavir	The serum concentration of Diazepam can be increased when it is combined with Saquinavir.

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