There are many possible interactions between recreational drugs and your HIV medication.
The following booster drugs are most likely to be involved in dangerous interactions with recreational drugs, recent research has shown:
You’ll be taking one of those if you’re taking a protease inhibitor, such as:
if you’ve been prescribed the combination drug Kaletra, which contains the booster ritonavir.
Because cobicistat and ritonavir boost the power of protease inhibitors, they can also boost recreational drugs to a dangerous extent. The booster drug works by causing the liver to process the antiretroviral more slowly, causing its levels to be higher.
Your body processes some recreational drugs in the same way as it processes protease inhibitors, so they can also be boosted by cobicistat and ritonavir.
Drugs with a high risk of interacting with cobicistat and ritonavir:
Drugs with a moderate risk of interacting with cobicistat and ritonavir:
Any risk is still serious – there have been deaths due to interactions between MDMA and ritonavir and crystal meth and ritonavir.
We don’t yet fully understand the different possible interactions, and advice changes over time as new evidence becomes available – that’s why it’s important to be upfront with your doctor or nurse about your drug use.
The risk of an interaction could be higher when you’ve just started to take HIV medication.
In these first weeks and months your body is getting used to processing antiretrovirals, so adding a recreational drug at this time could have added risks.
This information is by no means exhaustive – it’s an introduction to the most common interactions we currently know about. If you’re using recreational drugs, tell your HIV doctor about it – they’ll explain any risks to you in more detail.
Don’t be nervous about bringing up the subject – your doctor will be used to talking about recreational drug use with patients, and would much rather know about it in case it affects your HIV treatment.
Some non-nucleoside reverse transcriptase inhibitors (NNRTIs) can interact with some recreational drugs, making the levels lower because the liver processes them faster. This can be problematic if you take more of the recreational drug than you normally would, inject it or mix it with other drugs to try to get an effect.
The NNRTIs that can cause the interaction are:
The interaction affects the levels of:
A lot of the information on this page has come from www.aidsmap.com
Steroids and protease inhibitors can both raise levels of LDL (bad) cholesterol in the body. If you take anabolic steroids and are also taking a protease inhibitor, you need to be monitored closely, particularly if you have any risk factors for heart disease.
Poppers can interact with erectile dysfunction drugs such as Viagra, which can lead to a dangerous drop in blood pressure. Ritonavir and cobicistat can make this more likely.
NNRTIs including Efavirenz and nevirapine (Viramune) can reduce the levels of methadone in your body, resulting in the need for an increased dose. This needs to be monitored carefully to prevent you experiencing withdrawal symptoms.
The same can happen to a lesser degree with protease inhibitors and you may need an increased dose of methadone. Indinavir (Crixivan) has a lower chance of withdrawal symptoms.
Ritonavir reduces the blood levels of methadone and heroin so ritonavir-boosted protease inhibitors will have varying effects on methadone levels. Because of this, blood needs to be monitored.
There are no significant interactions between alcohol and HIV drugs. If drinking makes you vomit within an hour of taking HIV medication, take the dose again. However alcohol has been found to be more harmful if you’re living with HIV.
In addition, recent changes to Government guidelines recommend that both men and women should drink no more than 14 units each week.
If you take any other medication, however, check whether it’s safe to drink alcohol.
No known dangerous interactions with anti-HIV drugs.
According to the University of Liverpool HIV Drug Interactions site there are potential but unstudied interactions between the active substance of cannabis and the NNRTIs delavirdine (Rescriptor), efavirenz (Sustiva) and etravirine (Intelence), as well as with atazanavir (Reyataz).
We don’t yet know much about the risk of interactions between either of these drugs and antiretrovirals.
There was a case in 1999 where someone taking ritonavir and saquinavir nearly overdosed on GHB, raising concerns that protease inhibitors may increase levels of GHB. However there have been no further studies.
University of Liverpool’s Drug Interactions site advises that there are potential interactions between GHB and the protease inhibitor class of drugs as well as the booster drugs ritonavir and cobicistat, the NNRTI delavirdine (Rescriptor), the integrase inhibitor elvitegravir (Vitekta) and the combination drug E/C/F/TAF (elvitegravir (Vitekta), cobicistat (Tybost), emtricitabine (Emtriva) and tenofovir alafenamide fumarate.
However because of a lack of research most people conclude that the risk of interactions concerning GHB and GBL is relatively unknown.
See this drug interaction chart from University of Liverpool for more information.
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This article was last reviewed on
by Anna Peters
Date due for the next review: 25/5/2019
Content Author: Kerri Virani
Current Owner: Health Promotion
Interactions between HIV treatment and recreational drugs, Roger Pebody, NAM aidsmap, November 2015
HIV treatment ‘booster drugs’ are most likely to have dangerous interactions with methamphetamine, mephedrone, MDMA and ketamine - Interactions also possible between erectile dysfunction drugs and benzodiazepines, Roger Pebody, NAM aidsmap, August 2015
Interactions with recreational drugs, NAM aidsmap
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Various people talk about their experiences of living with HIV.
CAB - Citizens Advice Bureau
HIV Drug Interactions
George House Trust
Equality and Human Rights Commission
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