PMID- 12243611
OWN - NLM
STAT- MEDLINE
DCOM- 20030425
LR  - 20220310
IS  - 1060-0280 (Print)
IS  - 1060-0280 (Linking)
VI  - 36
IP  - 10
DP  - 2002 Oct
TI  - Interactions between recreational drugs and antiretroviral agents.
PG  - 1598-613
AB  - OBJECTIVE: To summarize existing data regarding potential interactions between 
      recreational drugs and drugs commonly used in the management of HIV-positive 
      patients. DATA SOURCES: Information was obtained via a MEDLINE search 
      (1966-August 2002) using the MeSH headings human immunodeficiency virus, drug 
      interactions, cytochrome P450, medication names commonly prescribed for the 
      management of HIV and related opportunistic infections, and names of commonly 
      used recreational drugs. Abstracts of national and international conferences, 
      review articles, textbooks, and references of all articles were also reviewed. 
      STUDY SELECTION AND DATA EXTRACTION: Literature on pharmacokinetic interactions 
      was considered for inclusion. Pertinent information was selected and summarized 
      for discussion. In the absence of specific data, prediction of potential 
      clinically significant interactions was based on pharmacokinetic and 
      pharmacodynamic properties. RESULTS: All protease inhibitors (PIs) and 
      nonnucleoside reverse transcriptase inhibitors are substrates and potent 
      inhibitors or inducers of the cytochrome P450 system. Many classes of 
      recreational drugs, including benzodiazepines, amphetamines, and opioids, are 
      also metabolized by the liver and can potentially interact with antiretrovirals. 
      Controlled interaction studies are often not available, but clinically 
      significant interactions have been observed in a number of case reports. 
      Overdoses secondary to interactions between the "rave" drugs 
      methylenedioxymethamphetamine (MDMA) or gamma-hydroxybutyrate (GHB) and PIs have 
      been reported. PIs, particularly ritonavir, may also inhibit metabolism of 
      amphetamines, ketamine, lysergic acid diethylmide (LSD), and phencyclidine (PCP). 
      Case series and pharmacokinetic studies suggest that nevirapine and efavirenz 
      induce methadone metabolism, which may lead to symptoms of opiate withdrawal. A 
      similar interaction may exist between methadone and the PIs ritonavir and 
      nelfinavir, although the data are less consistent. Opiate metabolism can be 
      inhibited or induced by concomitant PIs, and patients should be monitored for 
      signs of toxicity and/or loss of analgesia. PIs should not be coadministered with 
      midazolam and triazolam, since prolonged sedation may occur. CONCLUSIONS: 
      Interactions between agents commonly prescribed for patients with HIV and 
      recreational drugs can occur, and may be associated with serious clinical 
      consequences. Clinicians should encourage open dialog with their patients on this 
      topic, to avoid compromising antiretroviral efficacy and increasing the risk of 
      drug toxicity.
FAU - Antoniou, Tony
AU  - Antoniou T
AD  - HIV Program/Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
FAU - Tseng, Alice Lin-In
AU  - Tseng AL
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anti-HIV Agents)
RN  - 0 (HIV Protease Inhibitors)
RN  - 0 (Illicit Drugs)
RN  - 0 (Reverse Transcriptase Inhibitors)
RN  - 9035-51-2 (Cytochrome P-450 Enzyme System)
SB  - IM
MH  - Anti-HIV Agents/*pharmacokinetics/pharmacology
MH  - Cytochrome P-450 Enzyme System/metabolism
MH  - Drug Interactions
MH  - HIV Infections/complications/drug therapy/metabolism
MH  - HIV Protease Inhibitors/pharmacokinetics/pharmacology
MH  - Humans
MH  - Illicit Drugs/*pharmacokinetics/pharmacology
MH  - Reverse Transcriptase Inhibitors/pharmacokinetics/pharmacology
MH  - Substance-Related Disorders/complications/metabolism
RF  - 134
EDAT- 2002/09/24 06:00
MHDA- 2003/04/26 05:00
CRDT- 2002/09/24 06:00
PHST- 2002/09/24 06:00 [pubmed]
PHST- 2003/04/26 05:00 [medline]
PHST- 2002/09/24 06:00 [entrez]
AID - 10.1345/aph.1A447 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2002 Oct;36(10):1598-613. doi: 10.1345/aph.1A447.