Risky combinations

There are many possible interactions between recreational drugs (including alcohol) and your HIV medication - it is always safest to let your doctor or nurse know about any recreational drugs you use.

We do not fully understand the different possible interactions and advice changes over time as new evidence becomes available, but we do know that interactions between HIV medication and recreational drugs can often cause serious complications. These can sometimes lead to fatal overdoses, as one drug acts with another to increase its levels in your blood.

The risk is greatest when the body (in particular the liver) processes recreational drugs and HIV medication in the same way. For example, the liver processes many recreational drugs and protease inhibitors eg, ritonavir (Norvir), and Kaletra in the same way.

The risk of an interaction could be higher when someone has just started to take HIV medication. In these first weeks and months the body is getting used to processing them, so adding a recreational drug at this time could have added risks.

This is an introduction to the most common interactions currently known about, but it is by no means exhaustive. If you are using recreational drugs, it is advisable to tell your HIV doctor who will explain any the risks to you.

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.

A lot of the information on this page has come from www.aidsmap.com

• Ecstasy, GHB, GBL, crystal meth, speed, Viagra and other erection drugs. Taking these drugs at the same time as protease inhibitors (especially ritonavir) can raise levels of the recreational drug to dangerous levels. The most serious problems are thought to happen with ecstasy and GHB.
• Ecstasy - it is possible that taking these drugs at the same time non-nucleoside reverse transcriptase inhibitors (NNRTIs) including efavirenz (Sustiva) may raise levels of the recreational drug in the body.
• Anabolic steroids - steroids and protease inhibitors can both raise LDL (bad) cholesterol levels. 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.
• Viagra and poppers - taking Viagra and protease inhibitors can raise the levels of Viagra. It is recommended to have only a half dose of the erection drug. Taking poppers, Viagra and protease inhibitors together can lead to a dangerous drop in blood pressure.
• Methadone - 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.
• Methadone - Ritonivir 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.
• Alcohol – there are no significant interactions between any current anti HIV drugs and alcohol. If you take any other medication, however, check whether it is safe to drink alcohol.
• Cocaine and crack. No known dangerous interactions with anti-HIV drugs.
• Cannabis – We do not know how cannabis and anti-HIV drugs interact with each other, although a small US study found that cannabis use did not have an impact on the effectiveness of the protease inhibitor indinavir, despite them passing through the body in the same way.
• Acid – There are no known interactions with anti-HIV drugs.