Módulo 1 – Curso pós-graduado – VIH e Envelhecimento

Drug-drug Interactions and Polypharmacy in Older HIV Persons

Drug interactions and management of HIV infection

Autor: David Burger, PharmD PhD (Radboud University Nijmegen, Holanda)

The six-step strategy for management of drug interactions in HIV treatment

Given the need to manage drug interactions in the treatment of HIV infection, it is possible to define a strategy that consists of six steps:

  1. Assess whether there is a potential interaction (for instance, through the University of Liverpool website);
  2. Identify which drug is the “perpetrator” and which is the “victim”;
  3. Consult co-treating physicians the possibility to adjust or stop the co-medication.
  4. Select or change the antiretrovirals:
    • The preference may fall on antiretroviral with less risk of interaction, when beginning treatment in newly diagnosed patients or when changing from other antiretroviral with high potential for interactions (based on the University of Liverpool database);
    • Patients taking cobicistat, ritonavir, efavirenz or nevirapine have greater potential for interactions than patients taking RPV, RAL or DTG – which are the three drugs with less risk of interactions;
  5. If necessary, at initiation, switch or interruption of antiretroviral treatment, consult a clinical pharmacologist or send an email to IDPharmacology@umcn.nl;
  6. Monitor treatment efficacy, with the determination of plasma drug levels, blood pressure measurement (if any hypertension) and glucose levels (if there is a suspected interaction with metformin, for example), etc;
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