Drug-Drug Interactions

Some examples of potential drug-drug interactions (DDIs) between antiretroviral (ARV) drugs and agents used in the treatment of coronary heart disease, cerebrovascular disease and/or peripheral vascular disease are shown below, along with prescribing scenarios in which DDIs are considered unlikely:


  • refer to other sections of this website for information on related medical conditions, such as diabetes and dyslipidemia (upcoming)
  • for more information on specific DDIs access the HIV drug interactions website1
     

Atenolol, metoprolol and propranolol (beta blockers):1

  • no clinically significant interactions expected with non-nucleoside reverse-transcriptase inhibitors (NNRTIs), indinavir, nelfinavir or saquinavir
  • potential interactions with atazanavir, darunavir, lopinavir and ritonavir
  • tipranavir: should not be co-administered with metoprolol and potential interactions with atenolol and propranolol
  • fosamprenavir: potential interaction with metoprolol and no clinically significant interaction expected with atenolol or propranolol
  • data are not available for nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), maraviroc or raltegravir
     

Nifedipine (calcium channel blocker):1

  • potential interactions with protease inhibitor (PIs) and NNRTIs
  • data are not available for NRTIs, maraviroc or raltegravir
     

Bendroflumethiazide (thiazide diuretic):1

  • no clinically significant interactions expected with PIs, NNRTIs, NRTIs, maraviroc or raltegravir
     

Enalapril (angiotensin converting enzyme [ACE] inhibitor):1

  • no clinically significant interactions expected with PIs, NNRTIs, NRTIs, maraviroc or raltegravir

     

Aspirin (anti-platelet agent):1

  • no clinically significant interactions expected with PIs, NNRTIs, maraviroc or raltegravir
  • data are not available for NRTIs
     

All protease inhibitors (PIs) and certain NNRTIs inhibit CYP3A4. As the primary route of metabolism for most statins is via oxidation using CYP3A4, the possibility of DDIs should be considered when prescribing treatment for lipid profile management.2,3

Further studies

The Copenhagen HIV Programme is investigating the incidence of comorbidities among patients being treated for HIV infection. Their ongoing Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) trial is a prospective multi-cohort study of HIV-infected people under active follow up, is to assess the incidence of myocardial infarction among HIV/AIDS patients who are receiving antiretroviral therapy.

 

References

  1. The HIV drug interactions website. Accessed 6 May 2011.
  2. Dubé MP, Stein JH, Aberg JA, et al. Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis. 2003;37:613–627. 
  3. Fichtenbaum CJ, Gerber JG. Interactions between antiretroviral drugs and drugs used for the therapy of the metabolic complications encountered during HIV infection. Clin Pharmacokinet. 2002;41:1195–1211.