i-base

Recreational drugs and HIV meds

Summary of interations between anti-HIV medicines and recreational drugs, including opiate substitues and alcohol.

Drug Interaction Significance Recommendation
Alcohol None None None
Amphetamines Possible prolonged effect or higher concentrations with ARVS especially ritonavir High body temperature, high blood pressure, fast heartbeat, rapid breathing, seizures Avoid using with ritonavir if possible – or use less
Benzodiazepines Norvir may increase levels Over-sedation, respiratory depression Lower benzodiazepine dose if necessary
Cannabis None None None
Cocaine None None None
Ecstasy, MDMA Possible higher concentrations with ritonavir, other PIs and efavirenz 1 death reported – low sodium level in the blood, abnormal heartbeat, fast heartbeat, high body temperature, sweating, seizures, overactive reflexes, tremors, disintegration of muscle fibres. Avoid using with ritonavir if possible – or use less – stay hydrated and avoid alcohol.
GHB Possible interaction with ritonavir 1 case of near-fatal GHB poisoning with ritonavir + saquinavir – muscle spasms, seizures, slow heart rate, poor breathing, unconsciousness Caution with ritonavir, other PIs, efavirenz – be aware of signs of GHB toxicity.
Heroin, buprenorphine and methadone Efavirenz and nevirapine: methadone level up to 60% lower.Efavirenz: buprenorphine levels up to 50% lower. Ritonavir: may increase or decrease opiate level. Nelfinavir and Kaletra: reduces level of methadone. Methadone: decreases level of d4T and ddI, doubles level of AZT. Heroin: may be processed faster with PIs and efavirenz. Lower levels of methadone and heroin may lead to signs of withdrawal. Higher levels of ARVs may increase side effects. Higher dose of methadone may be needed. Use half the normal dose of AZT. No recommendation for d4T or ddI. Buprenorphine dose not usually changed.
Ketamine Possible higher concentrations with ritonavir, nelfinavir and efavirenz Poor breathing, unconsciousness, hallucinations Caution with ritonavir, other PIs, efavirenz – be aware of signs of ketamine toxicity.
LSD Possible higher concentrations Hallucinations, agitation, psychosis, flashbacks Caution with ritonavir, other PIs, efavirenz – be aware of signs of LSD toxicity.
PCP (angel dust) Possible higher concentrations High body temperature, high blood pressure, seizures, disintegration of muscle fibres. Caution with ritonavir, other PIs, efavirenz – be aware of signs of PCP toxicity.
Sildenafil (Viagra) and similar drugs Ritonavir increases level of erectile dysfunction agents Headache, priapism, palpitations, visual changes, low blood pressure. Use less (eg 25mg instead of 100mg sildenafil)

Source: based on T Auntonio and A Lin-in Tseng. Interactions Between Recreational Drugs and Anti-retroviral Agents, Annals of Pharmacotherapy. 2000, October, Volume 36.