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1
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- Interaction of Street Drugs with HIV Medications
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2
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- For most drugs to be effective and not kill you, they need to be
metabolized [broken down] by the liver or kidneys. These organs have
limited resources and a set number of chemicals which accomplish this
task. Because of this, certain drugs, whether they're HIV medications or
recreational drugs, can affect how other drugs act.
- This is called a drug interaction— and some of them can be deadly.
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3
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- There hasn't been much research on how street drugs and HIV medications
interact—because there is little financial incentive for the
pharmaceutical companies to do the work, and because the government
believes "just say no," is the only way to deal with drugs.
Certainly, your best bet is not to take street drugs at all if you are
taking HIV medications. But some interactions are deadlier than others.
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4
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- There has already been one death in England which resulted from a
regular dose of ecstasy (MDMA, X) taken with Norvir (ritonavir). Norvir
acts to slow down the liver enzyme that breaks down X—so it makes the
dose 5 to 10 times stronger.
- In addition, between 3-10% of the white population (the figure for other
populations is not known) have a deficiency in this enzyme, which may be
why some people overdose on what may be a safe dose for others.
- Since the amount of X varies in each pill, it is difficult to know how
much will put you in danger.
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5
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- If you are taking any protease inhibitor [ritonavir (Norvir), nelfinavir
(Viracept), indivar (Crixivan) saquinavir (Fortovase)] or non-nucleoside
reverse transcriptase inhibitor [neveripaine (Viramune)] delavirdine
(Rescriptor) or efavirenz (Sustiva)], X can be extremely dangerous.
- Of these, Norvir and Rescriptor seem to be the most dangerous, while
Viramune and Sustiva may be less so—although because effects in the test
tube have sometimes been opposite to those seen in the body, this is
hard to predict.
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6
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- If you do take X with a protease inhibitor, wait as long as possible
after taking the protease inhibitor to take the X, and be sure to have
someone with you who knows what you've done in case you have
difficulties. These overdoses are often not reversible, so it's really
better not to mix these drugs!
- Recent research has found that X damages serotonin neurons, so avoid it
if you have a family or personal history of depression or anxiety
disorders.
- Taking X while on HAART may lead you to roll for much longer. Some
people have reported rolling for 30 hours from two pills while taking
ritonavir and saquinavir.
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7
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- Use 25% of the usual amount of
MDMA
- Take breaks from dancing
- Make sure rave or party has medical team on site
- Maintain adequate hydration by avoiding alcohol and replenishing fluids
regularly
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8
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- Videx (ddI) can increase the risk of pancreatitis (intense stomach pain
that feels like it's going all the way through to your back. So, if
you're using alcohol regularly, don't use Videx. There are other
nucleosides to choose from.
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9
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- Occasional and light use of alcohol is not known to interact with other
HIV medications; however, chronic, heavy use can be destructive to the
liver. This can be dangerous because the way drugs are broken down can
be hurt. More drugs will stay in your system for the most part, which is
likely to cause overdoses and worse side effects. Alcohol can cause
dehydration; so be sure to drink lots of water to help your body deal
with any alcohol you drink.
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10
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- Protease inhibitors may increase THC levels (the active ingredient in
marijuana)—so smaller doses may make you more stoned. This is also true
of the synthetic version (Marinol) used in the treatment of weight loss.
Since THC overdose is impossible, this interaction is not dangerous.
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11
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- The sedatives Halcion (triazolam), Valium (diazepam), Ambiem (zolpidem)
and Versed (midazolam) can also be deadly if mixed with protease
inhibitors. Norvir has the largest negative effect. At high doses these
drugs can stop your breathing. Ativan (lorazepam), Serax (oxazepam) and
Restoril (temazepam) are safer with Norvir, and may actually be weakened
by it.
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12
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- Crixivan may increase blood levels of phenobarbital (Luminal), making
overdose more likely. Other protease inhibitor interactions are also
possible.
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13
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- There are no known interactions between cocaine and HIV medications, but
in the test tube, cocaine doubles the speed at which the virus
reproduces, meaning it may speed up how sick you get.
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14
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- Norvir seems to reduce heroin levels by 50% making overdose less likely.
However, this drug and the other protease inhibitors have sometimes been
known to have opposite effects (they cut methadone levels in real life,
while test tube experiments predicted they would increase them), so
caution is in order.
- Some synthetics sold as heroin (fentanyl, alpha-methyl-fentanyl) are
potent in tiny doses and could be deadly if mixed with another drug.
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15
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- Interactions between methadone and NNRTIs and PIs are highly likely.
- Sustiva and Viramune may cause withdrawal if taken while using
methadone. People on methadone maintenance may need higher doses of the
opiate. Norvir, Viracept, and possibly Kaletra may also cause similar
problems.
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16
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- Methadone may cause nucleosides to build up in the body and lead to
toxicity from AZT. Patients should be monitored for toxic reactions to
AZT including nausea, vomiting, headaches and low blood platelet levels.
- Methadone may decrease the anti-HIV action of Videx/ddI and Zerit while
taking methadone. This could lead to resistance in the virus and the
creation of more powerful strains of HIV. Taking the pill form (and not
the syrup) is thought to allow the drugs to pass through the stomach
without methadone weakening them.
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17
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- GHB is potentially dangerous with Norvir and other protease inhibitors.
- One man had serious life-threatening conditions after taking a small
amount of GHB to come down from an X trip. He was on ritonavir and saquinavir at
the time and had taken similar does of the rave drugs without problems
in the past.
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18
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- Glutathione is used by the liver to process amyl nitrite, and high
glutathione is linked with survival. If using amyl nitrite cuts
glutathione, it could lead to disease progression.
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19
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20
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21
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- PIs, Rescriptor, and possibly Sustiva work in the same liver pathway
that PCP is broken down in.
Taking PCP while using these drugs may result in high PCP
concentrations and cause toxic shock and/or death.
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22
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- When combined with Norvir, special K can lead to "chemical
hepatitis," an unpleasant inflammation of the liver resulting in
jaundice. A New York HIV doctor has seen two cases of it. Both went away
in several weeks. But anything which damages the liver can be a serious
problem for people living with HIV.
- Norvir, Viracept and Sustiva are suspected to cause special K to build
up in the body and lead to toxic shock.
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23
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- Amphetamines work the same way that X does in your body. As with X,
Norvir (ritonavir) should be avoided.
- Norvir is predicted to increase amphetamine levels in the blood by a
factor of 2-3.
- The other protease inhibitors should have less of an impact, but strange
opposite results are always possible.
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24
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- Norvir and other similar drugs can either strengthen Ritalin's effects
or make it weaker. Beware!
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25
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- Interactions not listed could be deadly. Street drugs are often not what
they are sold as, they are frequently cut with substances that may
interact with drugs themselves and their potency can vary wildly, even
in the same batch. With the lack of research in this area, it's better
to avoid potential interactions if at all possible.
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26
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- A recent article in the Annals of Pharmacotheraphy reviews the science
and medical cases of HIV med and street drug interactions. There are
also references in the article to studies, data, etc. that may be of
interest.
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27
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28
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- Back to the
- HIV Consumer Council Web Site
- http://www.hivcouncil.org
- With thanks to
- Mark Kinzly & Nabarun Dasgupta
- Yale School of Epidemiology and Public Health
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Notes
