AIDSWEEKLY Plus; Monday, December 16, 2002
Michael Greer, Senior Medical Writer

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."

A number of recreational drugs - including MDMA (Ecstacy), heroin, and LSD - can dangerously alter the pharmacokinetics of protease inhibitors (PIs) and other antiretroviral agents, Antoniou and coauthors found.

The researchers reviewed data from peer-reviewed studies found in the MEDLINE database and from a number of other sources, including textbooks and conference abstracts.

They focused on literature with information on hepatic drug metabolism through the cytochrome P450 pathway, which is used to break down antiretroviral agents as well as opioids, amphetamines, and other recreational drug classes, according to the report.

Protease inhibitors and nonnucleoside reverse transcriptase inhibitors (NNRTIs) strongly suppress cytochrome P450-based drug metabolism, and have been implicated in MDMA and gamma-hydroxybutyrate (GHD) overdoses, study data showed. Impaired metabolism of LSD, ketamine, methamphetamines, and phencyclidine (PCP) was also reported during PI therapy, and appeared to be particularly severe in patients treated with ritonavir.

Conversely, the NNRTIs nevirapine and efavirenz were reported to hasten methadone metabolism and may trigger the onset of withdrawal symptoms; this effect was also observed in some PI-treated patients (Interactions between recreational drugs and antiretroviral agents. Ann Pharmacother 2002 Oct;36(10):1598-613.

"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."

The corresponding author for this report is Alice Lin-in Tseng, Toronto General Hospital, Immunodeficiency Clinic, CW-G315, 101 College St., Toronto, ON M5G 2C4, Canada.

A search at www.NewsRx.net using the search term "AIDS and HIV therapy" yielded 1193 articles in 29 specialized reports.

Key points reported in this study include:

• Anti-HIV agents can dangerously alter metabolism of recreational drugs

• Overdoses of MDMA, GHB, and other drugs have been reported in patients undergoing antiretroviral therapy

• Conversely, some antiretrovirals hasten methadone metabolism and triggered withdrawal symptoms

• Antiretroviral drugs inhibit the cytochrome P450 metabolic pathway, used to break down many recreational drugs

This article was prepared by AIDS Weekly editors from staff and other reports.

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