Recreational Drugs Can Reduce Safety, Efficacy of Antiretroviral Agents

Canadian researchers warn that illicit drugs can trigger potentially lethal side effects in HIV patients on antiretroviral therapy. Tony Antoniou and colleagues at Toronto General Hospital conducted a study to "summarize existing data regarding potential interactions between recreational drugs and drugs commonly used in the management of HIV-positive patients." The investigators reviewed data from studies in the MEDLINE database and a number of other sources including textbooks and conference abstracts. They found a number of recreational drugs -- including MDMA (Ecstasy), heroin, and LSD -- can dangerously alter the pharmacokinetics of protease inhibitors and other antiretroviral agents.

Antiretroviral drugs inhibit the cytochrome P450 metabolic pathway, which is used to break down antiretroviral agents and opioids, amphetamines and other classes of recreational drugs, the study reported. PIs and nonnucleoside reverse transcriptase inhibitors (NNRTIs) strongly suppress cytochrome P450-based drug metabolism and have been implicated in MDMA and gamma-hydroxybutyrate overdoses, data showed. Impaired metabolism of LSD, ketamine, methamphetamines, and phencyclidine (PCP) was reported for patients on PI therapy. Reactions seemed particularly severe for those prescribed ritonavir. The NNRTIs nevirapine and efavirenz hastened methadone metabolism and possibly triggered withdrawal symptoms, an effect also found in some PI-treated patients, said the study. The full report, "Interactions Between Recreational Drugs and Antiretroviral Agents," was published in Annals of Pharmacotherapy (2002;36(10):1598-1613).

"Interactions between agents commonly prescribed for patients with HIV and recreational drugs can occur, and may be associated with serious clinical consequences," Antoniou and colleagues concluded. "Clinicians should encourage open dialog with their patients on this topic, to avoid compromising antiretroviral efficacy and increasing the risk of drug toxicity."

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