Pharmacotherapy Education and Research Center, College of Pharmacy, University of Texas, The University of Texas Health Science Center, San Antonio, TX, USA.
Ann Pharmacother. 2010 Dec;44(12):2014-7. doi: 10.1345/aph.1P346. Epub 2010 Nov 2.
To report a potential drug-drug interaction between enfuvirtide, an injectable HIV fusion inhibitor, and niacin in an HIV-infected man with dilated cardiomyopathy.
A 47-year-old HIV-infected man with dilated cardiomyopathy and prolonged QT syndrome with an automatic implantable cardiovascular defibrillator device was prescribed subcutaneous enfuvirtide 90 mg twice daily as part of his antiretroviral regimen and oral extended-release niacin 500 mg/day for a high-density lipoprotein level of 8 mg/dL. After 1 week of concomitant therapy, the patient began experiencing extreme redness, edema, and swelling at the injection site that corresponded with the flushing sensation due to niacin. This interfered with his daily activities, leading to self-discontinuation of both agents. As the patient had tolerated enfuvirtide therapy prior to the addition of niacin, we reinitiated enfuvirtide with close follow-up, and the patient has been maintained on this agent since then without consequence. Based on the Horn Drug Interaction Probability Scale, a probable interaction occurred between enfurvirtide and niacin.
We hypothesize that a drug-drug interaction occurs between enfuvirtide and niacin related to prostaglandin synthesis and mobilization of inflammatory cells, specifically Langerhans cells. A theoretical mechanism for this interaction is that the Langerhans cells in the epidermis function improperly due to the presence of HIV and the attachment of enfuvirtide. When these cells are exposed to nicotinic acid, an exaggerated immune response is produced that may lead to pain, redness, and swelling at the injection site. Prostaglandins, cytokines, and other inflammatory molecules may all have a role in this interaction.
Caution should be used when coadministering enfuvirtide and niacin to HIV-infected patients.
报告一名感染 HIV 的扩张型心肌病患者中恩夫韦肽（一种注射用 HIV 融合抑制剂）与烟酸之间潜在的药物相互作用。
一名 47 岁 HIV 感染男性，患有扩张型心肌病和延长 QT 综合征，带有自动植入式心血管除颤器装置，接受每日两次皮下注射恩夫韦肽 90mg 和口服烟酸缓释片 500mg，以将高密度脂蛋白水平提高至 8mg/dL。在联合治疗 1 周后，患者开始出现注射部位极度发红、水肿和肿胀，伴有烟酸引起的潮红感。这干扰了他的日常活动，导致他自行停用了两种药物。由于患者在加用烟酸之前已经耐受了恩夫韦肽治疗，因此我们密切监测后重新开始使用恩夫韦肽，此后患者一直使用该药物，没有出现任何不良后果。根据 Horn 药物相互作用概率量表，恩夫韦肽和烟酸之间可能发生了药物相互作用。
我们假设恩夫韦肽和烟酸之间发生药物相互作用与前列腺素合成和炎症细胞（特别是朗格汉斯细胞）的动员有关。这种相互作用的理论机制是，由于 HIV 的存在和恩夫韦肽的附着，表皮中的朗格汉斯细胞功能异常。当这些细胞暴露于烟酸时，会产生过度的免疫反应，可能导致注射部位疼痛、发红和肿胀。前列腺素、细胞因子和其他炎症分子都可能在这种相互作用中发挥作用。
在给 HIV 感染患者同时使用恩夫韦肽和烟酸时应谨慎。
