Summary of interations between anti-HIV medicines and recreational drugs
Including opiate substitues and alcohol
Table: ARV and street drug interactions summary
|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|
|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)|
Table based on: T Auntonio and A Lin-in Tseng. Interactions Between Recreational Drugs and Anti-retroviral Agents, Annals of Pharmacotherapy. 2000, October, Volume 36.
Last updated: 22 July 2009.