Pau Alice K
Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1880, USA.
Curr Opin HIV AIDS. 2008 May;3(3):319-24. doi: 10.1097/COH.0b013e3282f82c06.
Combination antiretroviral therapy has improved the morbidity and mortality of HIV-infected patients worldwide. As patients live longer, management of HIV infection extends to treatment of a wide spectrum of co-morbid conditions. Pharmacokinetic interactions are common among antiretroviral drugs when they are used in combination and along with treatments for other conditions. This review discusses the clinical significance of drug interactions among antiretroviral drugs and other medications, resources to use in assessing drug interaction potential, and some key principles to follow when managing patients prescribed potentially interacting drugs.
Targeted pharmacokinetic drug interaction studies and extrapolations on the basis of potential mechanism of interactions provide an initial basis for recommendations regarding use of certain drug combinations. Some unexpected interactions have emerged in the literature through case reports in which untoward effects were observed.
Management of patients on multiple drug therapy can be a challenge. The key to safe and effective therapy relies on the clinician's vigilance in their ongoing assessment of interaction potential among drugs prescribed to each patient, the significance for such interactions, the need for modification to therapy, and close follow up to assess safety and toxicity.
联合抗逆转录病毒疗法已改善了全球HIV感染患者的发病率和死亡率。随着患者寿命延长，HIV感染的管理扩展到对多种合并症的治疗。抗逆转录病毒药物联合使用以及与其他疾病的治疗药物合用时，药代动力学相互作用很常见。本综述讨论了抗逆转录病毒药物与其他药物之间药物相互作用的临床意义、用于评估药物相互作用可能性的资源以及在管理使用可能存在相互作用药物的患者时应遵循的一些关键原则。
有针对性的药代动力学药物相互作用研究以及基于潜在相互作用机制的推断为某些药物组合使用的建议提供了初步依据。通过观察到不良影响的病例报告，文献中出现了一些意想不到的相互作用。
对接受多种药物治疗的患者进行管理可能是一项挑战。安全有效治疗的关键在于临床医生在持续评估给每位患者开具的药物之间相互作用可能性、此类相互作用的重要性、治疗调整的必要性以及密切随访以评估安全性和毒性方面保持警惕。
