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Drwiega EN, Badowski ME, Michienzi S. Antiretroviral drug-drug interactions: A comparison of online drug interaction databases. J Clin Pharm Ther 2022; 47:1720-1724. [PMID: 36059105 PMCID: PMC9826109 DOI: 10.1111/jcpt.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/11/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Antiretrovirals have a high drug interaction potential, which can lead to increased toxicity and/or decreased efficacy. Multiple databases are available to assess drug-drug interactions. The aim of our study was to compare interaction identification for commonly used ARVs and concomitant medications between six different online drug-drug interaction databases. COMMENT This was a cross-sectional review using each of the following six databases: LexiComp®, Clinical Pharmacology®, Micromedex®, Epocrates®, University of Liverpool, and University of Toronto. Sixteen antiretroviral drugs and 100 of the DrugStats Database "Top 200 of 2019" list of medications were included. Each of the six databases identified a different number of actual or potential interactions. The number of interactions ranged from 211 to 283. WHAT IS NEW AND CONCLUSIONS A variety of databases exist with inconsistent identification of actual or potential drug-drug interactions amongst them. It may be beneficial to cross-reference multiple databases prior to making decisions regarding patient care.
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Affiliation(s)
- Emily N. Drwiega
- College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | - Sarah Michienzi
- College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
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2
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Giguère P, Nhean S, Tseng AL, Hughes CA, Angel JB. Getting to the Heart of the Matter: A Review of Drug Interactions Between HIV Antiretrovirals and Cardiology Medications. Can J Cardiol 2018; 35:326-340. [PMID: 30825953 DOI: 10.1016/j.cjca.2018.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 01/28/2023] Open
Abstract
The past 20 years have seen remarkable advances in the treatment of HIV such that most people diagnosed with HIV today can live long, healthy lives by taking antiretrovirals which are usually life-long. Advancements in antiretroviral therapy include the availability of well tolerated, single tablet regimens that are associated with a lower risk of drug-drug interactions. Despite this, many people living with HIV infection might be taking antiretroviral agents that are associated with significant drug-drug interactions. Because HIV infection itself is associated with cardiovascular complications and this population is living longer, concomitant use of antiretrovirals and medications to treat cardiovascular-related diseases is often required. For this reason, it is imperative that clinicians are aware of the potential for clinically significant drug-drug interactions between antiretroviral agents and cardiac medications as well as the useful HIV drug interaction resources that might provide guidance. Available data on significant interactions are summarized and suggested guidance regarding management is discussed.
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Affiliation(s)
- Pierre Giguère
- Department of Pharmacy, The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Salin Nhean
- University Health Network, Toronto, Ontario, and McGill University Health Centre, Montréal, Quebec, Canada
| | - Alice L Tseng
- University of Health Network, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Christine A Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan B Angel
- Faculty of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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3
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Yoong D, Naccarato M, Gough K. Reply: Extensive Bruising and Elevated Rivaroxaban Plasma Concentration in a Patient Receiving Cobicistat-Boosted Elvitegravir. Ann Pharmacother 2017. [DOI: 10.1177/1060028017716693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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4
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Chary A, Nguyen NN, Maiton K, Holodniy M. A review of drug-drug interactions in older HIV-infected patients. Expert Rev Clin Pharmacol 2017; 10:1329-1352. [PMID: 28922979 DOI: 10.1080/17512433.2017.1377610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The number of older HIV-infected people is growing due to increasing life expectancies resulting from the use of antiretroviral therapy (ART). Both HIV and aging increase the risk of other comorbidities, such as cardiovascular disease, osteoporosis, and some malignancies, leading to greater challenges in managing HIV with other conditions. This results in complex medication regimens with the potential for significant drug-drug interactions and increased morbidity and mortality. Area covered: We review the metabolic pathways of ART and other medications used to treat medical co-morbidities, highlight potential areas of concern for drug-drug interactions, and where feasible, suggest alternative approaches for treating these conditions as suggested from national guidelines or articles published in the English language. Expert commentary: There is limited evidence-based data on ART drug interactions, pharmacokinetics and pharmacodynamics in the older HIV-infected population. Choosing and maintaining effective ART regimens for older adults requires consideration of side effect profile, individual comorbidities, interactions with concurrent prescriptions and non-prescription medications and supplements, dietary patterns with respect to dosing, pill burden and ease of dosing, cost and affordability, patient preferences, social situation, and ART resistance history. Practitioners must remain vigilant for potential drug interactions and intervene when there is a potential for harm.
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Affiliation(s)
- Aarthi Chary
- a Department of Medicine , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,b Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine , Stanford , CA , USA
| | - Nancy N Nguyen
- c Department of Pharmacy , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,d Department of Pharmacy Practice, Thomas J. Long School of Pharmacy & Health Sciences , University of the Pacific , Stockton , CA , USA
| | - Kimberly Maiton
- d Department of Pharmacy Practice, Thomas J. Long School of Pharmacy & Health Sciences , University of the Pacific , Stockton , CA , USA
| | - Mark Holodniy
- a Department of Medicine , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,b Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine , Stanford , CA , USA.,e Office of Public Health Surveillance & Research , Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA
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5
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Allam A, Sak G, Diviani N, Schulz PJ. Do quality markers for health websites affect the perception of vaccination webpages? COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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6
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Lempers VJ, Brüggemann RJ. Antifungal therapy: drug–drug interactions at your fingertips. J Antimicrob Chemother 2015; 71:285-9. [DOI: 10.1093/jac/dkv350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Foisy MM, Tseng A. Development of a collaborative professional group for HIV pharmacists: experience from the Canadian HIV/AIDS Pharmacists Network. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2015; 23:232-3. [PMID: 25868487 DOI: 10.1111/ijpp.12164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michelle M Foisy
- Northern Alberta Program, Royal Alexandra Hospital, Edmonton, AB, Canada
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8
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Hughes CA, Tseng A, Cooper R. Managing drug interactions in HIV-infected adults with comorbid illness. CMAJ 2015; 187:36-43. [PMID: 25225224 PMCID: PMC4284166 DOI: 10.1503/cmaj.131626] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Christine A Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences (Hughes) and Division of Infectious Diseases, Department of Medicine (Cooper), University of Alberta, Edmonton, Alta.; Northern Alberta HIV Program (Hughes), Edmonton, Alta.; Toronto General Hospital (Tseng), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (Tseng), University of Toronto, Toronto, Ont.
| | - Alice Tseng
- Faculty of Pharmacy and Pharmaceutical Sciences (Hughes) and Division of Infectious Diseases, Department of Medicine (Cooper), University of Alberta, Edmonton, Alta.; Northern Alberta HIV Program (Hughes), Edmonton, Alta.; Toronto General Hospital (Tseng), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (Tseng), University of Toronto, Toronto, Ont
| | - Ryan Cooper
- Faculty of Pharmacy and Pharmaceutical Sciences (Hughes) and Division of Infectious Diseases, Department of Medicine (Cooper), University of Alberta, Edmonton, Alta.; Northern Alberta HIV Program (Hughes), Edmonton, Alta.; Toronto General Hospital (Tseng), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (Tseng), University of Toronto, Toronto, Ont
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9
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Abstract
Concomitant administration of multiple drugs can lead to unanticipated drug interactions and resultant adverse drug events with their associated costs. A more thorough understanding of the different cytochrome P450 isoenzymes and drug transporters has led to new methods to try to predict and prevent clinically relevant drug interactions. There is also an increased recognition of the need to identify the impact of pharmacogenetic polymorphisms on drug interactions. More stringent regulatory requirements have evolved for industry to classify cytochrome inhibitors and inducers, test the effect of drug interactions in the presence of polymorphic enzymes, and evaluate multiple potentially interacting drugs simultaneously. In clinical practice, drug alert software programs have been developed. This review discusses drug interaction mechanisms and strategies for screening and minimizing exposure to drug interactions. We also provide future perspectives for reducing the risk of clinically significant drug interactions.
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Affiliation(s)
- Cara Tannenbaum
- Université de Montreal, Centre de Recherche de l’Institut universitaire de gériatrie de Montréal,
4565 Queen Mary Road #4824, Montreal, Québec H3W 1W5, Canada
| | - Nancy L Sheehan
- Université de Montréal, and Chronic Viral Illness Service, McGill University Health Centre,
3650 St. Urbain, D2.01, Montréal, Québec H2X 2P4, Canada
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10
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Tseng A, Szadkowski L, Walmsley S, Salit I, Raboud J. Association of Age With Polypharmacy and Risk of Drug Interactions With Antiretroviral Medications in HIV-Positive Patients. Ann Pharmacother 2013; 47:1429-39. [DOI: 10.1177/1060028013504075] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Alice Tseng
- Toronto General Hospital, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Leah Szadkowski
- Toronto General Research Institute, University Health Network, ON, Canada
| | - Sharon Walmsley
- Toronto General Hospital, University Health Network, ON, Canada
- Toronto General Research Institute, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Irving Salit
- Toronto General Hospital, University Health Network, ON, Canada
- University of Toronto, ON, Canada
| | - Janet Raboud
- Toronto General Research Institute, University Health Network, ON, Canada
- University of Toronto, ON, Canada
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Important Drug-Drug Interactions in HIV-Infected Persons on Antiretroviral Therapy: An Update on New Interactions Between HIV and Non-HIV Drugs. Curr Infect Dis Rep 2012; 14:67-82. [PMID: 22125049 DOI: 10.1007/s11908-011-0229-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Advances in antiretroviral therapy have turned HIV into a chronic, manageable disease. Patients often require treatment for co-morbid conditions as well as HIV, and consequently, pharmacokinetic interactions between antiretrovirals (ARVs) and other drug classes are an increasing concern. Protease inhibitors and non-nucleoside reverse transcriptase inhibitors are involved in the CYP450 or other transporter systems, and may be associated with higher risk of clinically significant drug interactions. One reverse transcriptase inhibitor, abacavir, has demonstrated weak inhibition of CYP3A4, 2D6 and 2C9 in vitro, but is not associated with any clinically significant interactions involving the CYP450 system. The integrase inhibitor raltegravir is not involved in the CYP450 system, and may be a suitable option to use when trying to minimize interactions with other drug classes. This review summarizes recently published data on clinically significant drug interactions between ARVs and other drug classes including antineoplastics, immunosuppressant transplant drugs, directly acting antivirals for hepatitis C, antifungals, antimalarials, corticosteroids, psychotropics, hormonal contraceptives, anticoagulants, drugs for pulmonary hypertension, and herbal products. In situations of suspected or potential interactions, close monitoring is warranted, and dose adjustments or substitutions may be required.
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12
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Tseng A, Foisy M. Handbook and website on HIV drug therapy. Am J Health Syst Pharm 2012; 69:1284, 1286. [DOI: 10.2146/ajhp110721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Alice Tseng
- Toronto General Hospital 585 University Avenue, 13N-1314 Toronto, ON, Canada M5G 2N2
| | - Michelle Foisy
- Northern Alberta HIV Program Edmonton Clinic Health Academy Clinical Associate Professor Faculty of Pharmacy and Pharmaceutical Sciences University of Alberta Edmonton, Alberta Canada
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13
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Horvath KJ, Wilkerson JM, McFarlane M, Courtenay-Quirk C. Developing and maintaining HIV-related websites: a view from the other side. SEXUAL AND RELATIONSHIP THERAPY 2012. [DOI: 10.1080/14681994.2012.686662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Tseng A, Foisy M, Hughes CA, Kelly D, Chan S, Dayneka N, Giguère P, Higgins N, Hills-Nieminen C, Kapler J, la Porte CJL, Nickel P, Park-Wyllie L, Quaia C, Robinson L, Sheehan N, Stone S, Sulz L, Yoong D. Role of the Pharmacist in Caring for Patients with HIV/AIDS: Clinical Practice Guidelines. Can J Hosp Pharm 2012; 65:125-45. [PMID: 22529405 PMCID: PMC3329905 DOI: 10.4212/cjhp.v65i2.1120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alice Tseng
- , BScPhm, PharmD, FSCHP, AAHIVP, is with the Immunodeficiency Clinic of the Toronto General Hospital, Toronto, Ontario
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15
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Horvath KJ, Harwood EM, Courtenay-Quirk C, McFarlane M, Fisher H, Dickenson T, Kachur R, Rosser BRS, O'Leary A. Online resources for persons recently diagnosed with HIV/AIDS: an analysis of HIV-related webpages. JOURNAL OF HEALTH COMMUNICATION 2010; 15:516-31. [PMID: 20677056 DOI: 10.1080/10810730.2010.492562] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Internet is a major source of HIV-related information and resources for persons recently diagnosed with HIV/AIDS (PRDHA). This study examined the types of HIV-related websites that appear as a result of HIV-related keyword searches and the extent to which website information targets PRDHA. The first page of HIV-related webpages from 18 keyword searches was coded. Among 137 webpages meeting inclusion criteria, 63% represented HIV-informational websites, 31% targeted HIV-positive individuals, and over half contained or provided access to HIV prevention, treatment, and transmission information. Thirty-three percent of webpages contained or provided access to PRDHA-targeted information, with a greater percentage of those webpages having mobile, non-English, and "Ask the Expert" features compared with non-PRDHA targeted webpages. Implications for PRDHA include the following: (1) they should explore HIV-related websites to gain insight into the credibility of the information contained on those sites; (2) PRDHA must be aware that HIV-related websites have the potential to elicit dated, emotionally distressing, or irrelevant information; and (3) to obtain information that relates to their demographic and situational profile, they may wish to use specific key terms (e.g., "HIV women") rather than attempting to navigate webpages that arise from general search terms (e.g., "HIV"). Recommendations for future development of online resources for PRDHA include providing HIV-relevant information in a stepwise fashion, providing demographically targeted HIV information, and greater utilization of mobile technology.
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Affiliation(s)
- Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55454, USA.
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Villacorta Linaza P, Ruano Camps R, Gallego Fernández C, Santos Ramos B, Rodríguez Terol A, O Caraballo Camacho MDL. Calidad de las bases de datos sobre interacciones de antirretrovirales. Med Clin (Barc) 2010; 134:678-83. [DOI: 10.1016/j.medcli.2009.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 12/19/2009] [Accepted: 12/31/2009] [Indexed: 11/29/2022]
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17
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Yap KYL, Raaj S, Chan A. OncoRx-IQ: a tool for quality assessment of online anticancer drug interactions. Int J Qual Health Care 2010; 22:93-106. [DOI: 10.1093/intqhc/mzq004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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19
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Park-Wyllie LY, Levine MA, Holbrook A, Thabane L, Antoniou T, Yoong D, Kam D, Bayoumi AM. Outcomes of dosage adjustments used to manage antiretroviral drug interactions. Clin Infect Dis 2007; 45:933-6. [PMID: 17806064 DOI: 10.1086/521252] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Accepted: 06/04/2007] [Indexed: 11/03/2022] Open
Abstract
Dosage adjustments are often used to manage HIV drug interactions, but little is known about their clinical significance. We examined patients from the Ontario HIV Cohort Study to assess the effects of dosage adjustments on plasma viral load. A significant reduction (0.67 log10 copies/mL) in viral load was associated with adjustments to manage efavirenz-based interactions (95% confidence interval, -1.33 to -0.01) but was not observed after adjustments to manage rifabutin-based (difference in viral load, 0.03 log10 copies/mL; 95% confidence interval, -0.71 to 0.77) or nevirapine-based interactions (difference in viral load, 0.09 log10 copies/mL; 95% confidence interval, -0.83 to 1.01).
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Affiliation(s)
- Laura Y Park-Wyllie
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.
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Young B. Review: mixing new cocktails: drug interactions in antiretroviral regimens. AIDS Patient Care STDS 2005; 19:286-97. [PMID: 15916491 DOI: 10.1089/apc.2005.19.286] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Current highly active antiretroviral therapy (HAART) for the treatment of HIV infection requires the concomitant administration of three or four different agents, often with a high potential for drug-drug interactions. Additionally, some HIV-positive patients still require concomitant treatment with drugs for opportunistic infections, some require medication to treat unrelated medical conditions and/or the metabolic complications of antiretroviral therapy, others may self-medicate with herbal formulations and/or over-the-counter drugs, and still others many take drugs for recreational reasons or to manage addiction. Therefore, the virtually limitless number of drug combinations that may be taken by patients undergoing treatment of HIV infection makes drug-drug interactions almost inevitable. Managing these interactions is one of the major challenges associated with the multidrug regimens used for HIV therapy. This paper provides an overview of the most common interactions between antiretrovirals in the same and different classes-nucleoside analogue reverse transcriptase inhibitors (NRTI), protease inhibitors (PI), and non-nucleoside reverse transcriptase inhibitors (NNRTI)-by focusing on principles rather than specific interactions. The paper also addresses interactions between these antiretrovirals and other commonly used medications that may be prescribed concomitantly.
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