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Anticonvulsant and antiretroviral interactions
Michelle D Liedtke1, Staci M Lockhart, R Chris Rathbun
1Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA.
The Annals of Pharmacotherapy
|February 19, 2004
Summary
Interactions between anticonvulsant and antiretroviral drugs can cause serious toxicity and reduced treatment effectiveness. Newer anticonvulsants may offer safer alternatives, but careful monitoring is essential.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Infectious Diseases
Background:
- Anticonvulsant agents are frequently used in patients with epilepsy.
- Antiretroviral agents are crucial for managing HIV infection.
- Potential drug-drug interactions between these classes can impact patient outcomes.
Purpose of the Study:
- To evaluate the clinical significance of interactions between anticonvulsant and antiretroviral agents.
- To provide recommendations for the safe concurrent use of these medications.
Main Methods:
- A comprehensive PubMed search was conducted from 1966 to April 2003.
- Key search terms included drug names and "pharmacokinetic" and "drug interactions."
- Relevant articles and scientific meeting abstracts were reviewed.
Main Results:
- Six case reports detailed interactions between anticonvulsants and protease inhibitors.
- Carbamazepine levels increased with ritonavir, leading to toxicity; carbamazepine also reduced viral suppression with indinavir.
- Phenytoin levels decreased with nelfinavir, causing recurrent seizures; ritonavir's effect on phenytoin was variable.
Conclusions:
- Limited data exist on anticonvulsant-antiretroviral interactions.
- Valproic acid and newer anticonvulsants may be safer alternatives.
- Clinicians must diligently monitor for interactions to prevent toxicity and treatment failure.