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drug interaction

Aug 31, 2001

i won't go into the whole drawn out story, but i'm suffering from muscle spasticity and my neurologist wants to try botox injections. he says there is no contradiction with my hiv meds or risk of injection for an hiv+person. i'm on sustiva and combivir, my vl is undetectable, my t-cells are 250. do you know of any risk?

Response from Dr. Pavia

Two questions here, that I can see. One is the question of whether sustiva would interfere with the dosing of botox. It is great that you know to check out any new med when you are on an NNRTI or a protease inhibitor. In this case, I am not aware of a metabolic interaction, since botulinum toxin (botox) is not thought to be broken down through the cytochrome system in the liver.

I see a second question in there. Is there any risk of complications from injections of botulism toxin, one of the deadliest poisons known? As my daughter would say, "Well, duhhh" (See why they call it botox instead of botulinum toxin?). The answer is more complicated. In the hands of an experienced specialist, the results have been good and it has generally been very safe, but there is a long, long list of potential side effects. There is a long list of things that can go wrong if you get an overdose or it goes into a vein. None of these are likely, but you need to know about them.

Read some more about botox and ask your neurologists a lot of questions. It could well be a very good idea for you, but be informed, which is obviously what you are setting out to do.

Good luck


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