Módulo 1 – Curso pós-graduado – VIH e Envelhecimento

Drug-drug Interactions and Polypharmacy in Older HIV Persons

Polymedication and drug metabolism in aging patients

Autor: Marta Boffito, MD PhD (Chelsea and Westminster Hospital, London, UK)

Polymedication and risk of drug interactions

Polypharmacy can increase the chance of drug interactions at:

  • Drug absorption level, due to change of pH which is necessary for the absorption of some drugs (e.g., absorption of rilpivirine (RPV) and atazanavir (ATV) may be reduced with the simultaneous use of omeprazole) or due to chelation (e.g. in co-administration of antacids with cations and integrase inhibitors);
  • The level of first pass metabolism in the intestine and liver, associated with cytochrome P3A4 (CYP3A4);
  • Hepatic metabolism/elimination level, with the possible interaction with Phase I enzymes (e.g. CYP3A4) or Phase II enzymes (e.g. uridine 5’-diphospho-glucuronosyltransferase – UGT) but also in terms of transport proteins such as P-glycoprotein (P-gP) that has been increasingly studied;
  • Renal elimination level, which is affected by age and, in this context, can also be changed as a result of interactions at the level of transmembrane transporters.

Marzolini et al. described the most frequent co-medication in subjects with HIV infection and age >50 years, including cardiovascular drugs, such as antihypertensive and anticoagulants, hormone drugs, methadone, among others.3

Logo MSD Termos de utilização | Política de Privacidade | Sobre a MSD Copyright © 2018 Todos os direitos reservados. Merck Sharp & Dohme Corp.,uma subsidiária da Merck & Co., Inc. Kenilworth, NJ, USA, conhecida fora dos EUA e Canadá como MSD. Os conteúdos disponibilizados nesta página Web são informação de carácter geral e não substituem em nenhum caso as consultas, tratamentos ou as recomendações do seu médico. INFC-1273571-0000 11/2018