Microsoft word - recreational drugs and anti-hiv medication.doc

Information Services
Fact Sheet

RECREATIONAL DRUGS
AND ANTI-HIV
MEDICATION
Copyright The Eddystone Trust 2011
Updated November 2006
This information was kindly provided by the Dietetics team of the HIV /GU Medicine Directorate of the Chelsea and
Westminster Hospital. For more information please call 020 8746 8178.
It remains the copyright of the originator and The Eddystone Trust
We urge you to contact your GP, GUM Department or Consultant if you have any concerns regarding
your own health.

Recreational Drugs
the liver, is not noticeably affected by protease and Anti-HIV Medication
inhibitors. Some recent (test tube) research suggests that cocaine may cause HIV to multiply Protease Inhibitors are known to have significant faster: it is not clear what this means for users. and well-documented interactions with a number of prescribed drugs. However, it is hard to find Ecstasy & Speed
reliable facts about problems that can result from It is difficult to predict interactions of these drugs taking recreational drugs while on protease with protease inhibitors, as they are themselves a inhibitors, and/or other anti-HIV medications. cocktail and the formulas can vary. Ecstasy is metabolised (processed) in the liver using a Research faces a number of difficulties: pathway that is partially blocked by ritonavir. This means that if the two drugs are taken together, It is unclear how some illegal drugs are ritonavir may inhibit (slow down) Ecstasy's metabolism, resulting in two or three times the
Available information usually related to the expected level of Ecstasy in the blood stream.
This can be FATAL. Ritonavir may also cause a
than ecstasy – but ‘street’ drugs are rarely The level of a particular chemical in ‘street’ interactions are likely to be worse during the first drugs is not controlled – an ecstasy tablet six weeks of ritonavir treatment because this is levels of ritonavir are at their highest. It is probable that interactions will occur with other protease anxious not to be seen condoning illegal inhibitors, but there is very little information available. The interaction between non nucleoside reverse transcriptase inhibitors (NNRTI's) and enormously from individual to individual. The Ecstasy is largely unknown, however nevirapine enzymes involved in breaking down these has the opposite metabolic effect to ritonavir, and chemicals work at different rates in different speeds up the pathway through the liver, resulting people. in lower than usual blood levels of some other drugs. Delavirdine and efavirenz may also affect Cannabis & LSD
the way some recreational drugs are metabolised. There is no information available on interactions of these drugs with protease inhibitors although Crystal Meth
interactions may be possible. One of the main It is possible that crystal meth does not mix well side effects of Efavirenz, for at least the first with some antiretroviral medications as it is an couple of weeks, has been described by some patients as a “feeling of being stoned, or “trippy”. above).There have been a few case reports - but Cannabis, LSD or other ‘mind altering drugs’ could no comprehensive studies - involving individuals compound these effects. who died as a result of high blood concentrations of methamphetamine after taking ecstasy or Cocaine & Crack
crystal meth with one of these antiretrovirals. There is thought to be little chance of an What we don't yet know is to what extent interaction between coke or crack and protease antiretrovirals affect methamphetamine drug inhibitors however their use may cause you to forget to take your protease inhibitors. The methamphetamine affects antiretroviral drug enzyme, which breaks down these substances in levels in the body. If a decrease in antiretroviral drug levels occurs, this could translate into Tel: 0800 328 3508
www.eddystone.org.uk
The Eddystone Trust is a registered Charity and a Company Limited by guarantee.
Charity No:1078268 Company No: 3867526
premature treatment failure, drug resistance, and efavirenz resulting in an increase in their sedative disease progression. Crystal Meth use is also effect and their use with these anti-retrovirals associated with a rapid fall of CD4 cells, greater needs close clinical supervision, especially risk taking behaviour and reduced adherence to ritonavir. Temazepan levels are potentially halved and higher doses may be required to produce the same sedative effect. Dosage should not be increased automatically – close clinical Ritonavir, while inhibiting the production of some liver enzymes, is known to induce (increase) the production of others, notably those involved in the Protease Inhibitors, generally contribute to
breakdown of heroin. Heroin levels can decrease increased blood levels of and therefore possibly
in users on ritonavir and lopinavir/r. Heroin users adverse effects with Rohypnol,Anabolic Steroids
should not increase their dose to compensate. and Ketamine. It is possible, according to some
The metabolic rate will differ from person to
US information that using ritonavir and Ketamine person and increasing the dose of heroin creates can cause akind of acute chemically induced a real risk of overdose. hepatitis or liver inflammation. Anything, which damages the liver, can be a serious problemfor Methadone
people with HIV, and especially if you take Methadone is known to increase levels of zidovudine (AZT) in the blood. In practice, the dose of zidovudine is not adjusted unless side effects are experienced (e.g. nausea, anaemia). Viagra can interact with both prescription and Very little research has been done on the recreational drugs. Ritonavir can raise levels of interactions between methadone and other viagra by up to 300%, and the blood levels of nucleoside analogues but there have been no viagra can stay very high for a much longer period of time. Pfizer, the manufacturers of ritonavir have recommended that patients on ritonavir should not Protease inhibitors generally decrease methadone exceed a maximum single dose of 25mg of viagra levels in the blood. Particularly if you are on over a 48 hour period. Viagra can also interact ritonavir or lopinavir (Kaletra) the dose of with amyl and other nitrates (poppers). Using both methadone may need to be increased if there are of these together could cause dangerously low signs of withdrawal. Nevirapine and efavirenz can blood pressure, leading to dizziness, fainting, or also decrease the methadone levels in the blood. even a heart attack or stroke. This may be made The dose of methadone may need to be increased even worse whilst taking ritonavir or other if withdrawal effects are experienced. prescription drugs that interact with viagra, such This usually occurs 7-10 days after starting as ketoconazole, itraconazole and the anti-biotic nevirapine or efavirenz. Extra care needs to be erithromycin. Age and other factors like heart taken with efavirenz as the side effects of this drug may be mistaken for methadone withdrawal. If you are on methadone you should not change GHB (gamma hydroxybuytrate)
your dose without first contacting your prescriber, Not a lot is known about GHB, although the most usually your GP, Drug Dependancy Unit (DDU) or critical 'don't' in relation to this drug is don't mix it drug service. with alcohol. People have died from doing just that. But it's also potentially dangerous when Benzodiazepines, Rohypnol, Anabolic Steroids mixed with drugs like ritonavir, which can affect
and Ketamine
Sedatives like Valium (diazepam) and some 'benzos' interact with protease inhibitors and If you are taking anti-HIV medication:
Tel: 0800 328 3508
www.eddystone.org.uk
The Eddystone Trust is a registered Charity and a Company Limited by guarantee.
Charity No:1078268 Company No: 3867526
then speak to your doctor as it could affect your
treatment regimen.
Sharing equipment
As well as the risk of transmission of HIV from
sharing IV equipment, there is recent research to
suggest that the Hepatitis C virus may be
transmitted when drugs are snorted. If the tissues
up the nose are traumatised, blood may be
present which may not be visible to the naked
eye. If this occurs when people share equipment
the virus may be transmitted from one person to
the other.
If you are worried about drug use and want to talk
to someone here are some useful telephone
numbers:
National Drugs Helpline (Freephone) 0800 77 66
00 24 hours
Mainliners 020 7582 5226 (Mon – Fri 10 – 6.00)
Narcotics Anonymous 020 7730 0009
Tel: 0800 328 3508
www.eddystone.org.uk
The Eddystone Trust is a registered Charity and a Company Limited by guarantee.
Charity No:1078268 Company No: 3867526

Source: http://www.eddystone.org.uk/wp-content/uploads/2011/03/Eddystone-HIV-Fact-Sheet-Recreational-Drugs-and-Anti-HIV-Medication.pdf