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How to Avoid Adverse Reactions to HIV/AIDS Medications

Treatment Watch

June 1998

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Not all drug interactions are harmful. Certain drugs can actually increase the potency of others. AZT, for example, has been shown to increase the potency of ddI.

In this issue's article, however, adverse reactions associated with certain drug combinations will be examined.

Many examples in the tables accompanying this article (see below) point to an increase in liver toxicity and peripheral neuropathy, bone marrow suppression and risk of pancreatitis with certain combinations. In particular, antacids and antiulcer agents have a tendency to decrease the levels of certain medications. Antibiotics in combination have a tendency to either suppress the bone marrow, increase liver toxicity, or decrease the efficacy of some of these drugs, while it is extremely important to consider how certain antivirals combine together. Finally, ingesting alcohol can increase one's risk of pancreatitis, especially when taken with ddI and other medications that are associated with such a risk.

These tables detail some potential interactions associated with various antiretrovirals. They are by no means complete listings, nor are they meant to suggest that all of these interactions will have some clinical significance with each individual. The tables are meant to initiate conversations between you and your care providers.

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Not every interaction was elaborated upon in the Comment column, yet they should still be areas of concern to discuss with your care provider. Sometimes a dosage adjustment or discontinuation of a specific therapy can alleviate the potential of certain interactions.


Non-nucleoside reverse transcriptase inhibitors
Drug Interaction Concerns with Rescriptor (delavirdine mesylate)
Drug
Class
Generic
Name
Brand
Name
Potential
for:
Comments
Antacids Maalox, Mylanta, Rolaids, etc.Decreased absorption of RescriptorTake at least 2 hours apart
Antiseizure CarbamazepineTegretolDecreased Rescriptor levels  
PhenytoinDilantinDecreased Rescriptor levels
Antiulcer agentCimetidineTagametDecreased Rescriptor levelsTake at least 2 hours apart
RanitidineZantacDecreased Rescriptor levelsTake at least 2 hours apart
Antiviraldidanosine, ddIVidexDecreased antiviral activityTake 1 hour apart
Antibiotic RifabutinMycobutinDecreased Rescriptor levelsAvoid using together
RifampinRifadinDecreased Rescriptor levelsAvoid using together
 
Drug Interaction Concerns with Viramune (nevirapine)
Drug
Class
Generic
Name
Brand
Name
Potential
for:
Comments
AntibioticAmoxicillinAmoxilIncreased risk of skin rashes and Stephen-
Johnson syndrome
Potentially life-threatening. Discontinue use and seek medical care.
ClarithromycinBiaxinIncreased risk of liver toxicity 
ErythromycinErycetteIncreased risk of liver toxicity
RifabutinMycobutinDecreased Viramune levels
RifampinRifadinDecreased Viramune levels
Antiulcer agentCimetidineTagametDecreased Viramune levels 
RanitidineZantacDecreased Viramune levels
AntiseizurePhenytoinDilantinDecreased Viramune levels 

Nucleoside analogues
Drug Interaction Concerns with Retrovir (Zidovudine, AZT)
Drug
Class
Generic
Name
Brand
Name
Potential
for:
Comments
AntifungalAmphotericin BFungizoneBone Marrow Damage  
FlucytosineAncobonBone Marrow Damage
Antibiotic Trimethoprim /
Sulfamethoxazole
Bactrim Bone Marrow Damage -- Decreased red blood cells and neutrophilsMonitor for anemia and neutropenia. May require supportive G-CSF therapy.
ClarithromycinBiaxinReduced AZT levelsMay need to adjust AZT dose
DapsoneDapsone USPBone Marrow DamageMonitor for anemia and neutropenia. May require supportive G-CSF therapy.
RifampinRifadinDecreased antiviral activityMay need to adjust AZT dose
Antiviral Stavudine, d4TZeritDecreased antiviral activityNot recommended by DHHS Guidelines
CytoveneGanciclovirDecreased neutrophilsMay require supportive G-CSF therapy
zalcitabine, ddCHIVIDIncreased risk of pancreatitisMonitor amylase and lipase
AntiprotozoalPentamidinePentam 300Bone Marrow DamageMonitor for anemia and neutropenia. May require supportive G-CSF therapy.
Pyrimethamine + SulfadiazineDaraprim + SulfadiazineBone Marrow DamageMonitor for anemia and neutropenia. May require supportive G-CSF therapy.
 
Drug Interaction Concerns with Videx (didanosine, ddI)
Drug
Class
Generic
Name
Brand
Name
Potential
for:
Comments
Antiulcer agentCimetidineTagametDecreased absorptionTake 2 hours apart
AntibioticDapsone Dapsone USPIncreased peripheral neuropathy. Decreased dapsone absportion.Take 2 hours apart to avoid absorption concerns
Antiviralzalcitabine, ddCHividIncreased peripheral neuropathy and risk of pancreatitisMonitor amylase and lipase
delaviridine mesylateRescriptorDecreased antiviral activityTake 1 hour apart
GanciclovirCytoveneReduced ganciclovir levels and increased risk of pancreatitis 
AntifungalKetoconazoleNizoralReduced ketoconazole activityUse alternative antifungal or take 2 hours apart
AntiprotozoalPentamidinePentam 300Increased risk of pancreatitisMonitor amylase and lipase
 
Drug Interaction Concerns with HIVID (zalcitabine, ddC)
Drug
Class
Generic
Name
Brand
Name
Potential
for:
Comments
Antiviralzidovudine, AZTRetrovirIncreased risk of pancreatitisMonitor amylase and lipase
Antiulcer agentCimetidineTagametDecreased ddC levels 
Antacids Maalox, Mylanta, Rolaids, etc.Decreased ddC levels 
AntiprotozoalPentamidinePentam 300Increased risk of peripheral neuropathy and pancreatitisMonitor amylase and lipase for pancreatitis
 
Drug Interaction Concerns with Zerit (stavudine, d4T)
Drug
Class
Generic
Name
Brand
Name
Potential
for:
Comments
Antiviralzidovudine, AZTRetrovirDecreased antiviral activityNot recommended by DHHS Guidelines
GanciclovirCytoveneIncreased risk of pancreatitisMonitor amylase and lipase
AntiprotozoalPentamidinePentam 300Increased risk of pancreatitisMonitor amylase and lipase
 
Drug Interaction Concerns with Epivir (lamivudine, 3TC)
Drug
Class
Generic
Name
Brand
Name
Potential
for:
Comments
Antiulcer agentCimetidineTagametDecreased levels of Epivir and/or CimetidineMay need to adjust dosage of either Epivir or Tagamet
RanitidineZantacDecreased levels of Epivir and/or Ranitidine 
AntibioticEthambutolMyambutolDecreased levels of Epivir and/or Ethambutol 


Additionally, the following drugs may increase the risk of peripheral neuropathy when taken with HIVID (ddC): Aminoglycosides, Amphotericin B, Antineoplastics, Chloramphenicol, Cisplatin, Dapsone, Disulfiram (Antabase), Foscarnet, Ethionamide, Hydralazine, Iodoquinol, Isoniazid, Metronidazole, Pentamidine, Phenytoin, Probenecid, and Ribavirin. This same list may also to apply to Videx (ddI) and Zerit (d4T), and peripheral neuropathy may also increase when the three drugs (ddC, ddI, and d4T) are used in combinations together. Also, use of Retrovir (AZT) and Pentamidine when taken with HIVID (ddC) may increase the risk of pancreatitis.


Glenn Gaylord is a Treatment Advocate with AIDS Project Los Angeles. He can be reached via e-mail: ggaylord@apla.org or by calling (213) 993-1509.


This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!



  
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This article was provided by AIDS Project Los Angeles. It is a part of the publication Positive Living.
 
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