MANAGEMENT OF DRUG-INTERACTIONS IN PATIENTS WITH HIV

OBJECTIVE: To provide a compilation of relevant information on drug in teractions to assist healthcare practitioners in managing complex HIV- related pharmacotherapy. DATA SOURCES: Information was retrieved via a MEDLINE search (January 1966-December 1996) using MeSH headings ''hum an immunodeficiency virus,'' ''drug interactions,'' and names of medic ations commonly prescribed for the management of HIV infection and rel ated opportunistic infections. Abstracts of international and national conferences, review articles, textbooks, and references of all articl es were also searched. STUDY SELECTION AND DATA EXTRACTIONS: All liter ature on pharmacokinetic or pharmacodynamic interactions was considere d for inclusion. Pertinent information, as assessed by the authors, wa s selected and summarized for discussion. DATA SYNTHESIS: Drug disposi tion and/or pharmacologic effect may be affected either by HIV-related physiologic changes or by the presence of concomitant drug therapy. M odifications in drug selection, dosage, dosing regimen, or route of ad ministration may be needed to avoid or manage drug-disease, drug-drug, or drug-food interactions. Management options may depend on the mecha nism and the clinical significance of the interaction, the availabilit y of therapeutic alternatives, patient convenience, and cost restricti ons. In the absence of specific data, consideration of pharmacokinetic and pharmacodynamic characteristics to assist practitioners in predic ting the likelihood of possible interactions was included. RESULTS: A comprehensive table of clinically significant drug interactions is pro vided. Drug interaction principles and practical management strategies are also discussed. CONCLUSIONS: The potential for drug interactions is extremely common, given the increasing complexity of managing patie nts infected with HIV, To avoid compromising therapeutic efficacy or i ncreasing drug toxicity, practitioners need to be aware of potential i nteractions and are encouraged to use a systematic approach when manag ing patient drug therapy.