Drug Interactions: HIV Medications, Street Drugs and Methadone
Drug Interactions: HIV Medications, Street Drugs and Methadone
A drug interaction is what happens when one drug that you take affects the way another drug you take works in your body. An interaction can affect your body's ability to break down one drug or both drugs. It can also affect the strength or effectiveness of one drug or both drugs. Drug interactions become more complicated -- and more likely to happen -- the more drugs you take. In many cases, interactions aren't a problem. There are lots of drugs that don't affect each other at all. But some medications should never be used together because they combine to create a toxic reaction. Such interactions are dangerous, even life threatening.
The liver breaks down and absorbs (metabolizes) antiretrovirals for HIV, methadone, alcohol, street drugs like cocaine and heroin, prescription and over-the-counter medications, herbs, vitamins -- the works. The liver has primary responsibility for drug metabolism, but the kidneys also play a role, mostly by eliminating drugs. Specific pathways of enzymes in the liver metabolize different drugs, but many drugs are metabolized by the same pathways. This is where interactions can occur.
The liver can only do so much work at one time. If you take two or more drugs at once, they can compete for the same enzymes in the liver in order to be broken down. This competition can affect the way the drugs are metabolized. One drug might be metabolized faster than usual, reducing levels of the drug in your blood and making it less effective. This could be a problem with a number of drugs. If your methadone levels are too low, for example, you could experience serious withdrawal symptoms. And if your anti-HIV drug is at low levels, it won't work as well and could allow your virus to become resistant to that drug and, perhaps, others as well.
Another kind of interaction can cause one of the drugs you're taking to be metabolized more slowly than usual. You could end up with a dangerously high dose of the drug in your system because it isn't being broken down and absorbed properly. In essence, this could cause an overdose and, depending on the drug, could be fatal.
It might be useful to think of the liver as a funnel -- or many funnels, some of them having funnels within them. If drug A and drug B compete with one another for the same funnel, for example, a number of possibilities could occur:
- The levels of both Drug A and Drug B could increase in your system;
- The levels of both Drug A and Drug B could decrease in your system;
- Drug A levels could increase in your system and Drug B levels could decrease;
- Drug A levels could decrease in your system and Drug B levels could increase;
- Drug A levels could increase in your system and Drug B could remain at normal levels;
- Drug A levels could decrease in your system and Drug B could remain at normal levels;
- Drug A could remain at normal levels in your system and Drug B levels could decrease;
- Drug A could remain at normal levels in your system and Drug B levels could increase; or
- Both Drug A and Drug B could remain at normal levels in your system.
The more drugs you add to the mix, the more difficulty the funnels may have metabolizing them properly. There are many possible interactions -- some of them may not cause a problem, but others certainly could.
The following describes known and potential drug interactions that involve medications to treat HIV or prevent and treat opportunistic infections. Some of this information is based on studies that have been conducted in test tubes, animals, or people; some of it is based on case reports -- incidents that have actually happened to people; and some of the information is theoretical, based on what we know about how different drugs are metabolized -- which pathways they use and how they use them.
|HIV Medications and Street/Recreational Drugs|
There hasn't been much research on how illegal street drugs and HIV medications interact. Certainly, your best bet is not to use street drugs at all if you're taking HIV medications. But some interactions are known to be more dangerous than others.
It's difficult to study interactions between illegal drugs and antiretrovirals. Some people have a higher tolerance to some drugs than other people do. Also, there are too many different kinds of cuts put on drugs, especially heroin and cocaine, which are hardly ever pure. So laboratory tests using pure heroin or cocaine, for example, wouldn't necessarily tell us what might happen in your body with drugs bought on the street.
We have more information about interactions with prescription drugs that are used recreationally, But even then, some drugs that are available by prescription, when bought on the street, may be cut with other substances that could cause unexpected interactions with other drugs.
Amphetamines (Speed, Methamphetamine, Crystal Meth [Tina, Ice])
Cocaine (Coke, Blow, Crack)
Ecstasy (MDMA, X)
GHB (Gamma-Hydroxy-Butyrate, Grievous Bodily Harm, Liquid X, G)
Heroin (Dope, Smack, Brown, Junk, China White)
Ketamine (Special K)
LSD (Acid, Blotter)
PCP (Angel Dust, Rocket Fuel)
Poppers (Amyl Nitrate or Butyl Nitrate)
Sedatives and Tranquilizers
Barbiturates (Barbs, Downers)
Benzodiazepines (Bennies, Benzos, Downers)
Bottom line: Mixing downs can be very dangerous. Mixing depressant drugs -- alcohol and opioids; alcohol and barbiturates; alcohol and benzodiazepines; or a combination of depressant drugs -- is the cause of most overdose deaths.
Viagra (Sildenafil), Levitra (Vardenafil), and Cialis (Tadalafil)
If you're on a protease inhibitor, don't take more than one 25 mg dose of Viagra within a two-day period.
If you're on a protease inhibitor-containing regimen that doesn't include Norvir, the highest dose of Levitra should be 2.5 mg within a 24-hour period.
If you're taking Kaletra or Norvir (even at a low dose) as part of your regimen, the highest dose of Levitra should be 2.5 mg and it shouldn't be taken again for three days.
If you're taking erythromycin, don't take more than one 5 mg dose of Levitra in a 24-hour period.
If you're taking 200 mg of Nizoral a day, your dose of Levitra shouldn't be more than 5 mg in one day; and if you're taking 400 mg of Nizoral a day, your dose of Levitra shouldn't be more than 2.5 mg in one day.
If you're taking Norvir (including low-dose Norvir), Nizoral, or Sporanox, your dose of Cialis should be 10 mg no more than once in three days.
Grapefruit juice could increase levels of Cialis in your blood, so avoid it if you take that drug.
Levitra can decrease levels of the protease inhibitor Crixivan, so if you're taking Crixivan three times a day (which is rare), it would be safer to use Viagra or Cialis at lower doses than usually recommended.
Levitra and Cialis are relatively new compared to Viagra, which has been on the market since 1998. As more people use these drugs and further studies are conducted, we'll learn more about their safety and other possible interactions.
|HIV Medications and Methadone|
The same liver enzymes that metabolize methadone break down many medications for HIV and drugs that prevent and treat opportunistic infections. So these drugs can cause changes in the way you respond to your methadone dose. Some can increase the effects of methadone; others can decrease it. Methadone can have an effect on the strength of some anti-HIV drugs, too.
It's best to tell both your HIV healthcare provider and the provider at your methadone clinic about all the medications you're taking. But if you don't share the information, at least know the drugs that you're on. Most of the important methadone-medication interactions decrease the effect of the methadone. If your dose isn't comfortable for you, it isn't "addictive behavior" to want one that is.
People considering detoxing from methadone should be aware that this might not be a good idea for some people with HIV, particularly if your CD4 count is low. Methadone-maintained people have fewer hospitalizations and are more likely to receive anti-HIV medications than many heroin users who aren't on methadone. When lowering your methadone dose it may be safest to go slowly and wait until you've adjusted to each decrease before moving on to the next one.
The following are some of the known drug interactions with methadone. There may be others. This area, like most involving drug users, hasn't been thoroughly studied -- although, because methadone is legal, the information about possible drug interactions is more complete and there's more of it compared to that for illegal drugs. If you start a new medication and find that your methadone dose isn't "holding" you or that it makes you feel drowsy or over-medicated, talk to the provider at your clinic. If they refuse to adjust your methadone to meet your needs, ask your HIV care provider to discuss it with them. You shouldn't have to suffer because of ignorance about drug interactions from some clinic staff.
Drugs That May Make Methadone Stronger (More Potent)
Drugs With Mixed or Contradictory Effects
Drugs That Make Methadone Weaker (Less Potent)
Drugs That Methadone Makes Weaker
Drugs That Methadone Makes Stronger
James Learned is Director of Treatment Education at ACRIA and Editor of ACRIA Update.
Maia Szalavitz is the co-author of Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems (Wiley, 2000).
Thanks to Carlos Santiago and Constance T. Chang for their research assistance.
Select Primary and Secondary References
- Booker B, et al. Lack of effect of methadone (MET) on the pharmacokinetics (PK) of delavirdine (DLV) and N-delavirdine (N-DLV) [abstract #A-490]. 41st Interscience Conference on Antimicrobial Agents and Chemotherapy; 2001 December 16-19; Chicago, Illinois.
- Agenerase (amprenavir) label.
- Alderman CP, Frith PA. Fluvoxamine-methadone interaction. Aust NZ J Psychiatry 1999 Feb;33(1):99-101.
- Altice FL, Cooney E, Friedland GH; Nevirapine induced methadone withdrawal: implications for antiretroviral treatment of opiate dependent HIV infected patients. Conf Retroviruses Opportunistic Infect 1999 Jan 31-Feb 4; 6th:137 (abstract no. 372).
- Altice FL, Friedland GH, Cooney EL. Nevirapine induced opiate withdrawal among injection drug users with HIV infection receiving methadone. AIDS. 1999;13:957-962.
- Antoniou T, Tseng AL. Interactions between recreational drugs and antiretroviral agents. Ann Pharmacother. 2002 Oct;36(10):1598-1613.
- Ativan (lorazepam) label.
- Ayres WA, et al. The bogus drug: Three methyl & alpha methyl fentanyl sold as "China White". J Psychoactive Drugs. 1981 Jan-Mar;13(1):91-3.
- Bagasra O, Pomerantz RJ. Human immunodeficiency virus type 1 replication in peripheral blood mononuclear cells in the presence of cocaine. J Infect Dis. 1993 Nov;168(5):1157-64.
- Baker R, et al. Ritonavir and ecstasy. BETA 1997 Mar 5.
- Barry M, Gibbons S, Back D, Mulcahy F. Protease inhibitors in patients with HIV disease. Clinically important pharmacokinetic considerations. Clin Pharmacokinet. 1997 Mar;32(3):194-209.
- Bart P-A, et al. Methadone blood concentrations are decreased by administration of abacavir plus amprenavir. Ther Drug Monit 2001;23:553-555.
- Bart PA, et al. Ther Drug Monit 2001;23:553-555.
- Bertschy G, Baumann P, Eap CB, Buettig D. Probable metabolic interaction between methadone and fluvoxamine in addict patients. Ther Drug Monit 1994 Feb;16(1):42-5.
- Bochner F. Drug interactions with methadone: pharmacokinetics. In Hummeniuk induction and stabilisation of patients onto methadone. Monograph Series 39, Canbera: Commonwealth of Australia; 2000: 93-110.
- Bornheim LM, et al. Characterization of cannabidiol-mediated cytochrome P450 inactivation. Biochem Pharmacol. 1993 Mar 24;45(6):1323-31.
- Bornheim LM, et al. Human hepatic microsomal metabolism of delta 1-tetrahydrocannabinol. Drug Metab Dispos. 1992 Mar-Apr;20(2):241-6..
- Burrows DL, Hagardorn AN, Harlan GC, et al. A fatal drug interaction between oxycodone and clonazepam. J Forensic Sci. 2003 May;48(3):683-6.
- Chrisman CR. Protease inhibitor-drug interactions: proceed with caution, J Critical Illness 2003; 18(4):185-188.
- Cialis (tadalafil) label.
- Clarke S, et al. Absence of opioid withdrawal symptoms in patients receiving methadone and the protease inhibitor lopinavir-ritonavir, Clin Infect Dis 2002;34:1143-5.
- Clarke SM, et al. Pharmacokinetic interactions of nevirapine and methadone and guidelines for use of nevirapine to treat injection drug users, Clin Infect Dis 2001;33:1595-7.
- Clarke SM, et al. The pharmacokinetics of methadone in HIV-positive patients receiving the non-nucleoside reverse transcriptase inhibitor efavirenz, Br J Clin Pharmacol 2001;51:213-7.
- Cobb M, et al. The effect of fluconazole on the clinical pharmokinetics of methadone. Clinical Pharmaco Ther 1998;63;655-622.
- Crixivan (indinavir) label.
- Crowley JR, et al. Mechanism-based inactivation of rat liver cytochrome P4502B1 by phencyclidine and its oxidative product, the iminium ion, Drug Metab Dispos 1995 Aug; 23(8):786-93.
- Dalmane (flurazepam) label.
- De la Torre R, et al. Non-linear pharmacokinetics of MDMA ("ecstasy") in humans. Br J Clin Pharmacol. 2000 Feb; 49(2):104-9.
- DeMaria Jr. PA, Methadone drug interactions. Journal of Maintenance in the Addictions 2003; 2(3):69-74.
- DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, October 29, 2004.
- Eap CB, et al. Interindividual variability of the clinical pharmacokinetics of methadone: implication for the treatment of opioid dependence. Clin Pharmacokinet 2002;41(14):1153-1193.
- Faragon J and Piliero P, Drug Interactions Associated With HAART: Focus on Treatments for Addiction and Recreational Drugs, AIDS Reader 13(9):433-450, 2003.
- Forney RB & Hughes FW. Meprobamate, ethanol or meprobamate-ethanol combinations on performance of human subjects under delayed autofeedback (DAF), Journal of Psychology 1964 57:431-436.
- Fortovase (saquinavir SGC) label.
- Friedland G, Rainey P, Jatlow P, et al. Pharmacokinetics (pK) of didanosine (ddI) from encapsulated enteric coated bead formulation (EC) versus chewable tablet formulation (EC) in patients (pts) on chronic methadone therapy. XIV International AIDS Conference; July 7-12, 2002; Barcelona, Spain. Abstract TuPeB4548.
- Geletko SM, et al. Decreased methadone effect after ritonavir initiation. Pharmacotherapy 2000;20:93-4.
- Girre, C, et al. Detection of blood benzodiazepines in injured people. Relationship with alcoholism. Drug and Alcohol Dependence 1998;21(1):61-65.
- Gourevitch MN. Interactions between HIV-related medications and methadone: an overview, Mt. Sinai J Med 2001; 68(3):227-228.
- Greenblatt DJ, et al. Differential impairment of triazolam and zolpidem clearance by ritonavir. Acquir Immune Defic Syndr. 2000 Jun 1;24(2):129-36.
- Greenblatt DJ, et al. Differential impairment of triazolam and zolpidem clearance by ritonavir, J Acquir Immune Defic Syndr 2000; 24:129-36.
- Guibert A, et. al. In vitro effect of HIV protease inhibitors on methadone metabolism (Abstract A-58). 37th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, September 28-October 1, 1997.
- Halcion (triazolam) label.
- Harrington RD, et al. Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma-hydroxybutyrate, Arch Intern Med 1999 Oct 11;159(18):2221-4
- Haverkos HW, et al. Health hazards of nitrite inhalants. Am J Med. 1988 Mar;84(3 Pt 1):479-82.
- Heelon MW, Meade LB. Methadone withdrawal when starting an antiretroviral regimen including nevirapine. Pharmacotherapy. 1999;19:471-472.
- Hendrix C, et al. Pharmacokinetic (PK) and pharmacodynamic (PD) evaluation of methadone (MD) enantiomers following co-administration with amprenavir (APV) in opioid-dependent subjects [abstract #1649] 40th Interscience Conference on Antimicrobial Agents and Chemotherapy; 2000 September 17-20.
- Henry JA, et al. Fatal interaction between ritonavir and MDMA. Lancet 1998;352:1751-2.
- Herrlin K, et al. Methadone, ciprofloxacin, and adverse drug reactions. Lancet. 2000 Dec 16;356(9247):2069-70.
- Hollister LE. Interactions between alcohol and benzodiazepines. Recent Dev Alcohol. 1990;8:233-9.
- Hsu A, et al. Ritonavir: Clinical pharmacokinetics and interactions with other anti-HIV agents. Clin Pharmacokinet 1998; 35:275-91.
- Hsyu PH, Lillibridge JH, et al. Pharmacokinetic (PK) and pharmacodynamic (PD) interactions between nelfinavir and methadone. Conf Retroviruses Opportunistic Infect 2000 Jan 30-Feb 2; 7:91 (abstract no. 87).
- Inoue T, et al. Effects of inducers and/or inhibitors on metabolism of lysergic acid diethylamide in rat liver microsomes, Xenobiotica 1980 Dec;10(12):913-20.
- Invirase (saquinavir HGC) label.
- Jones C. Suspicious death related to gamma-hydroxybutyrate (GHB) toxicity, J Clin Forensic Med 2001 Jun; 8(2):74-6.
- Jung F, et al. Diazepam metabolism by cDNA-expressed human 2C P450s: identification of P4502C18 and P4502C19 as low K(M) diazepam N-demethylases. Drug Metab Dispos, 1997 Feb; 25(2):133-9.
- Kaletra (lopinavir/ritonavir) label.
- Kalvik A, et al. Help for heroin dependence: what pharmacists need to know about methadone maintenance therapy. Pharmacy Practice 1996; 12(10):43-54.
- Kharasch ED, et al. Influence of hepatic and intestinal cytochrome P4503A activity on the acute disposition and effects of oral transmucosal fentanyl citrate. Anesthesiology. 2004 Sep;101(3):729-37.
- Klonopin (clonazepam) label.
- Kosel BW, Aweeka FT, Benowitz NL, et al. The effects of cannabinoids on the pharmacokinetics of indinavir and nelfinavir. AIDS. 2002;16:543-550.
- Kreek MJ, et al. Rifampin-induced methadone withdrawal. N Engl J Med 1976; 294:1104-1106.
- Kreek MJ. Drug interactions with methadone in humans. In: Braude MC, Ginzburg HM (eds). Strategies for Research on the interactions of Drugs of Abuse, NIDA Research Monograph 68. 1986:193-225.
- Kreth K, et al. Identification of the human cytochromes P450 involved in the oxidative metabolism of "Ecstasy"-related drugs. Biochem Pharmacol 2000;15:1563-71.
- Kronbach T, et al. Oxidation of midazolam and triazolam by human liver cytochrome P450IIIA4. Mol Pharmacol 1989 Jul; 36(1):89-96.
- Laurenzana EM, et al. Metabolism of phencyclidine by human liver microsomes, Drug Metab Dispos. 1997 May; 25(5):557-63.
- Levitra (vardenafil) label.
- Levy RH, et al. (eds), Metabolic Drug Interactions, Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
- Lexiva (fosamprenavir) label.
- Lim ML, et al. A two-way drug interaction between lopinavir/ritonavir and phenytoin [abstract #535], 10th Conference on Retroviruses and Opportunistic Infections; 2003 February 10-14; Boston, Massachusetts.
- Lin LY, et al. Cytochrome P4502D isozymes catalyze the 4-hydroxylation of methamphetamine enantiomers. Drug Metab Dispos 1995;23:610-614.
- Lin LY, et al. Oxidation of methamphetamine and methylenedioxymethamphetamine by CYP2D6. Drug Metab Dispos 1997;25:1059-1064.
- Maroldo L, Manocchio S, et al. Lack of effect of nelfinavir mesylate on maintenance methadone dose requirement (abstract WePeB4120) Presented at: XIII international AIDS Conference, Durban, South Africa, July 9-14, 2000; 60.
- McCance-Katz EF, et al. Methadone effects on zidovudine disposition (AIDS Clinical Trials Group 262). J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Aug 15;18(5):435-43.
- McCance-Katz EF, et al. Modified directly observed therapy (MDOT) for injection drug users with HIV disease, Am J Addict. 2002;11(4):271-278.
- McCance-Katz EF, et al. The protease inhibitor lopinavir-ritonavir may produce opiate withdrawal in methadone-maintained patients. Clin Infect Dis. 2003 Aug 15;37(4):476-82.
- McCance-Katz EF, Rainey PM, Smith P, et al. Drug interactions between opioids and antiretroviral medications: interaction between methadone, LAAM, and nelfinavir. Am J Addict. 2004 Mar-Apr;13(2):163-80.
- McCance-Katz, EF, et al. Letter to the Editor: Decrease in Methadone Levels With Nelfinavir Mesylate. Am J Psychiatry 157:481, March 2000.
- McDowell JA, et al. Pharmacokinetic interaction of abacavir (1592U89) and ethanol in human immunodeficiency virus-infected adults. Antimicrob Agents Chemother. 2000 Jun;44(6):1686-90.
- Medline Plus, U.S. National Library of Medicine and the National Institutes of Health.
- Mills KC. Serotonin syndrome. Am Fam Physician. 1995 Oct;52(5):1475-82.
- Mirken B. Danger: possibly fatal interactions between ritonavir and "ecstasy," some other psychoactive drugs. AIDS Treat News. 1997 Feb 21;(No 265):5.
- Moolchan ET, et al. Therapeutic drug monitoring in methadone maintenance: choosing a matrix. J Addict Dis 2001;20(2):55-73.
- Nilsson MI, et al. Effect of urinary pH on the disposition of methadone in man. Eur J Clin Pharm 1982; 22: 337-342.
- Norvir (ritonavir) label.
- Ono S, et al. Human liver microsomal diazepam metabolism using cDNA-expressed cytochrome P450s: role of CYP2B6, 2C19 and the 3A subfamily. Xenobiotica 1996 Nov; 26(11):1155-66.
- Otero MJ, Fuertes A, Sanchez R, et al. Nevirapine-induced withdrawal symptoms in HIV patients on methadone maintenance programme: an alert. AIDS. 1999 May 28;13(8):1004-5.
- Palkama VJ, et al. Effect of saquinavir on the pharmacokinetics and pharmacodynamics of oral and intravenous midazolam. Clin Pharmacol Ther 1999 Jul; 66(1):33-9.
- Peterson PK, et al. Cocaine potentiates HIV-1 replication in human peripheral blood mononuclear cell cocultures. Involvement of transforming growth factor-beta. J Immunol. 1991 Jan1; 146(1): 81-4.
- Physicians' Desk Reference (PDR) entry for Rifadin (rifampin capsules).
- Pinzani V, Faucherre V, Peyriere H, et al. Methadone withdrawal symptoms with nevirapine and efavirenz. Ann Pharmacother. 2000;34:405-407.
- Preston, A. The Methadone Briefing. London: ISDD, 1996. (out of print) See online version.
- Quinn DI, et al. Pharmacokinetic and pharmacodynamic principles of illicit drug use and treatment of illicit drug users. Clin Pharmacokinet. 1997; 33(5):344-400.
- Rainey PM, et al. Interaction of methadone with didanosine and stavudine. J Acquir Immune Defic Syndr 2000; 24(3):241-248; The 6th CROI - Conf Retroviruses Opportunistic Infect 1999 Jan 31-Feb 4; 6th:137 (abstract no. 371).
- Rescriptor (delavirdine) label.
- Retrovir (zidovudine, AZT) label.
- Reyataz (atazanavir) label.
- Richelson E. Pharmacokinetic drug interactions of new antidepressants: a review of the effects on metabolism of other drugs. Mayo Clin Proc. 1997; 72:835-847.
- Roth MD, et al. Cocaine enhances Human Immunodeficiency Virus Replication in a Model of Severe Combined Immunodeficient Mice Implanted with Human Peripheral Blood Luekocytes. J Infect Dis. 2002 Mar 1;185(5):701-5.
- Sellers E, et al. The pharmacokinetics of abacavir and methadone following coadministration, CNAA1012 (abstract 663) Presented at 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, September 26-28, 1999:25.
- Shelnutt SR, et al. Phencyclidine metabolite irreversible binding in the rat: gonadal steroid regulation and CYP2C11, J Pharmacol Exp Ther. 1996 Apr; 277(1):292-8.
- Staszewski S. Nevirapine/didanosine/lamivudine once daily in HIV-1-infected intravenous drug users. Antivir Ther. 1998;3 Suppl 4:55-6.
- Stocker H, et al. Nevirapine significantly reduces the levels of racemic methadone and (R)-methadone in human immunodeficiency virus-infected patients. Antimicrob Agents Chemother. 2004 Nov;48(11):4148-53.
- Strang J (chair), Drug Misuse and Dependence -- Guidelines on Clinical Management, The Scottish Office Department of Health. Welsh Office and the Department of Health and Social Services: Norwich, UK; 1999.
- Sustiva (efavirenz) label.
- Tanaka E. Toxicological interactions between alcohol and benzodiazepines. J Toxicol Clin Toxicol. 2002;40(1):69-75.
- U.S. Drug Enforcement Administration: Benzodiazepines.
- Valium (diazepam) label.
- Versed (midazolam HCI Injection) package insert.
- Viagra (sildenafil) label.
- Videx (didanosine, ddI) label.
- Viracept (nelfinavir) label.
- Viramune (nevirapine) label.
- Whitfield RM, et al. The impact of ethanol and Marinol/marijuana usage on HIV+/AIDS patients undergoing azidothymidine, azidothymidine/dideoxycytidine, or dideoxyinosine therapy. Alcohol Clin Exp Res 1997 Feb;21(1):122-7.
- Yanagihara Y, et al. Involvement of CYP2B6 in n-demethylation of ketamine in human liver microsomes, Drug Metab Dispos 2001 Jun; 29(6):887-90.
- Zerit (stavudine, d4T) label.
- Ziagen (abacavir) label.