HIV-infected individuals usually receive a wide variety of drugs in addition to their antiretroviral drug regimen. Since both non-nucleoside reverse transcriptase inhibitors and protease inhibitors are extensively metabolised by the cytochrome P450 system, there is a considerable potential for pharmacokinetic drug interactions when they are administered concomitantly with other drugs metabolised via the same pathway. In addition, protease inhibitors are substrates as well as inhibitors of the drug transporter P-glycoprotein, which also can result in pharmacokinetic drug interactions. The nucleoside reverse transcriptase inhibitors are predominantly excreted by the renal system and may also give rise to interactions. This review will discuss the pharmacokinetics of the different classes of antiretroviral drugs and the mechanisms by which drug interactions can occur. Furthermore, a literature overview of drug interactions is given, including the following items when available: coadministered agent and dosage, type of study that is performed to study the drug interaction, the subjects involved and, if specified, the type of subjects (healthy volunteers, HIV-infected individuals, sex), antiretroviral drug(s) and dosage, interaction mechanism, the effect and if possible the magnitude of interaction, comments, advice on what to do when the interaction occurs or how to avoid it, and references. This discussion of the different mechanisms of drug interactions, and the accompanying overview of data, will assist in providing optimal care to HIV-infected patients.

https://dspace.library.uu.nl/bitstream/handle/1874/29429/maat_03_druginteractionsbetweenantiretroviral.pdf?sequence=2

Drug Interactions Between Antiretroviral Drugs and Comedicated Agents

Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

https://russjcardiol.elpub.ru/jour/article/download/3801/2841

As millions of patients with HIV/AIDS are put on treatment with the highly active antiretroviral therapy (HAART), drug interactions have become a major concern for healthcare providers. The use of HAART as a combination of 3 - 4 drugs creates potential for antiretroviral (ARV) drug interactions, and this is complicated by the addition of other drugs for treatment of other ailments such as comorbid chronic conditions and/or opportunistic infections. It has been observed that most ARV drug interactions involve drugs that interact with CYP enzymes. Specifically, protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) are the most implicated in ARV drug interactions and are metabolised by CYP isoenzymes. Because PIs and NNRTIs can also inhibit and induce some of the CYP isoenzymes, they often interfere with the metabolism of several drugs eliminated by CYP isoenzymes, and the converse is true. The drug groups most implicated in CYP-mediated interactions with ARV drugs include: rifamycins; statins; antibiotics; antifungals; antiulcer drugs; contraceptives; immunosuppressant drugs; drugs for erectile dysfunction; drugs of abuse; drugs for treatment of addiction; benzodiazepines; anticonvulsants; psychotropic agents; herbal products; antiarrhythmias; antimalarials; anticoagulants; and antiasthma drugs. Unfortunately, this information is published in different resources where it may not be accessible to many, and is also liable to misinterpretation if read in isolation. Here, this information has been pooled and discussed with a hope that it will enable appropriate use in patients with HIV/AIDS. The review was confined to CYP-associated ARV drug interactions to emphasise that prevention of ARV drug interactions requires thorough knowledge of CYP function and regulation by healthcare providers.

The role of cytochrome P450 in antiretroviral drug interactions.

Objective:To review the literature for information regarding interactions between warfarin and antiretroviral agents and evaluate the clinical significance of these interactions.Data Sources:Primary literature was identified through a search of MEDLINE (1950–July 2008) and International Pharmaceutical Abstracts (1970–July 2008) using individual antiretroviral drug names and the following key search terms: warfarin, antiretroviral, protease inhibitor, nonnucleoside reverse transcriptase inhibitor, cytochrome P450,2C9, HIV, and drug interactions. Relevant abstracts from infectious disease and HIV conferences (2005–2008), reference citations from relevant articles, and manufacturers' product information were also reviewed.Study Selection and Data Extraction:All English-language articles identified through the data search were examined. Studies and reports addressing warfarin interactions with antiretrovirals, CYP2C9 polymorphism, and antiretroviral CYP2C9 effects were evaluated. A total of 12 case reports we...

Warfarin–Antiretroviral Interactions

Drug interactions involving protease inhibitors are common. Protease inhibitors are well known inhibitors of the 3A4 isozyme of cytochrome P450. Select protease inhibitors, including co-formulated lopinavir/ritonavir, may induce glucuronidation or the activity of other CYP450 isozymes. We describe the case of a patient taking warfarin who experienced a significantly decreased international normalized ratio after the initiation of antiretroviral therapy that included lopinavir/ritonavir. We review the possible mechanisms of this interaction and the reported interactions between warfarin and other protease inhibitors.

/pdf/interaction-between-lopinavir-ritonavir-and-warfarin-vgrll8koxq.pdf

Interaction between lopinavir/ritonavir and warfarin

Influence of indinavir and ritonavir on warfarin anticoagulant activity

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Influence of indinavir and ritonavir on warfarin anticoagulant activity