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Drug
interactions
Taking recreational or illicit drugs with HIV antiviral
drugs can be dangerous. The effects are unpredictable, but are influenced
by a few variables, including:
-
the level of anti-HIV drugs in your bloodstream (the time at which you
took the last dose);
- how
well your liver breaks down certain drugs (there is no way of measuring
this);
-
the potency, purity and amount of other drugs you take.
We don’t know all the possible interactions between
HIV treatments and illicit drugs. There could be interactions or effects
that have not been recorded or reported before. The strength and quality
of illicit drugs will vary, depending on the source. They are probably
cut with other things. This makes it even harder to make blanket statements
about interactions.
To
be perfectly safe, you should never combine illicit drugs with prescribed
HIV medications. However, the following measures may reduce the risk of
interactions.
-
•
Reduce the amount of any illicit drug you take. Take only a quarter
to one third of the amount you might otherwise take.
- •
Discuss any illicit drugs you use or plan to use with a doctor
you can trust.
- •
Try not to take other drugs at exactly the same time as your
HIV antiviral medication. Taking your drugs a little while apart could
reduce the chance of interactions, but it won’t necessarily prevent
it.
Always
have plenty of water at hand to prevent dehydration. You should drink
roughly 600 mls, or just a little more than half a litre of water, per
hour.
Your
anti-HIV drugs prevent the virus from replicating. You need to maintain
them at the right levels in your blood for them to work. So-called drug
holidays – stopping your treatments for short periods of time – can cause
the virus to become resistant to anti-HIV medications.
If you think you are feeling weird, or think you might be having a drug
interaction (e.g. vomiting, nausea, dizziness, or feeling like you’re
about to pass out) don’t be afraid to call an ambulance, or go to straight
to a medical centre or hospital casualty department.
Specific Interactions
Ecstasy and amphetamines (speed and E) and protease inhibitors
HIV protease inhibitors, particularly ritonavir (Norvir) can interact
dangerously with speed or with ecstasy. The interaction between ritonavir
and ecstasy has been linked to a death in the UK. Using E and ritonavir
together could possibly push up the level of ecstasy in the bloodstream,
causing an E overdose. Don’t take E and ritonavir (or another protease
inhibitor) at exactly the same time. Wait a few hours between taking each
of the drugs, so that your liver has a chance to begin breaking each one
down separately.
Combining other amphetamines – like speed – with protease
inhibitors could cause potentially fatal interactions. Reduce the amount
of speed you take by a third to a quarter, particularly if you are using
drugs from an unfamiliar source or supplier. Snorting or bombing rather
than injecting may be advisable.
Cocaine
There are no well-documented reports of particular interactions. Some
recent research does suggest that cocaine may cause HIV to multiply faster.
Heroin
It does not appear that protease inhibitors and other antivirals increase
levels of heroin in the blood.
Cannabis and efavirenz
Efavirenz (Stocrin) can make you feel a little disoriented. Particularly
for the first 2-3 weeks, some people say the drug makes them feel dizzy,
and report symptoms similar to “being stoned”, or “tripping”. Cannabis
or dope might make these feelings worse.
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