Treatment training manual

3.14 Recreational drugs, alcohol, vitamins, supplements and complementary therapy

Some HIV drugs interact with other drugs and compounds. This includes recreational drugs, street drugs and substitution therapy. It also includes complementary or traditional herbal therapies.

Even over-the-counter medicine like antacids and multivitamins can interact with some HIV medicines.

The interactions can be complicated.

Sometimes the interactions will increase the amount of recreational drugs found in blood to dangerous levels.

Some recreational drugs can reduce the levels of HIV drugs. This increases the risk for drug resistance.

  • Over-the-counter antacids can interact with some integrase inhibitors and atazanavir (though this is now rarely used).
  • Multivitamins can also interact with integrase inhibitors. This involves taking supplements at a different time to ART.
  • Tenofovir (TD) interacts with some non-steroidal anti-inflammatory drugs (NSAIDs) that are sold over the counter. For example: diclofenac, ibuprofen and naproxen.

Your doctor and pharmacist therefore need to know about any other drugs or supplements that you use. Even if you only use them sometimes. Your doctor will treat this information in confidence.

Alcohol does not interact with HIV medications.

But, more heavy alcohol use, as with recreational drug use, might make it easy to forget your meds. It would help if your healthcare workers know about this.

Several studies report high alcohol use and is linked to detectable viral load.

Further reading

  1. The free online Liverpool HIV Drug Interaction checker has the most detailed information about likely interactions. This resource lets you enter your HIV meds and pick the other drugs that might interact. It will then make an individualised PDF print-out of the potential interactions.
    hiv-druginteractions.org/checker
  2. Liverpool University summary of drug interactions between ART drugs and recreational/illegal drugs.
    https://liverpool-hiv-hep.s3.amazonaws.com/prescribing_resources/pdfs/000/000/033/original/TS_Recreational_2019_Oct.pdf?1571043606
  3. Interactions between ARVs and street drugs – Older medical review (from 2003) on interactions between different street and recreational drugs and antiretrovirals.Maybe now be out-of-date,

Last updated: 1 January 2023.