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Switch On Your HIV Smarts.

Don’t use poppers with Viagra, and other critical drug interaction advice

, by San Francisco AIDS Foundation

The Dr. Is InTwice a month, the San Francisco AIDS Foundation program Positive Force hosts free The Dr. Is In events for people living with HIV in our community. Dr. Neal Sheran, the special populations clinical chief at the HIV clinic at Mission Neighborhood Health Center, selects speakers for the event that share information about HIV health and wellness and other topics of concern for people living with HIV.

This month, Dr. Sheran invited Maria Lopez, PharmD, AAHIVP, and Sam Zakkour, PharmD from Mission Wellness Pharmacy to lead a discussion and answer questions about drug interactions, and share what people should do if they’re starting a new medication. Here’s what we learned.

Why do we care about drug interactions—for people living with HIV or others?

Medications

HIV medications, and other medications, are designed to flow through our bodies at a certain rate and concentration in order to have the right effects. HIV medications, when they are taken at the right dose and on the right schedule, are available in the body at the right concentration and for the right amount of time to suppress a person’s viral load.

But some medications, if they’re taken together, can influence each other by changing how quickly or slowly they are processed by the body and how concentrated they are when they’re in the body. When a drug interaction causes one of the drugs to be increased in concentration, people might experience more side effects from the drug. When a drug interaction causes a drug to decrease in concentration, the drug might not work. For people living with HIV, a decrease in drug concentration can be especially problematic because it can cause HIV to develop resistance to the medication.

A warning about supplements and over-the-counter medications

Many people may assume that over-the-counter medications, multivitamins and herbal supplements are safe to take without consulting a pharmacist or worrying about potential drug interactions. This isn’t always the case, warned Lopez and Zakkour.

Ask your pharmacist or primary care provider if you plan on starting a new medication—even if you only plan on taking it every once in a while.

— Maria Lopez, PharmD, AAHIVP, and Sam Zakkour, PharmD

from Mission Wellness Pharmacy

There are many readily available supplements and medications that people should ask their pharmacist or care provider about before taking, even if they’re only planning on taking the medication for a short time or sporadically. Here are a few examples of drug interactions that can cause problems (although by no means is this a comprehensive list).

  • Antacids, like Pepcid, Prilosec and Tums can interact with some HIV medications.
  • Multivitamins and supplements that contain calcium, iron, magnesium and/or aluminum can prevent some HIV medications from being properly absorbed.
  • Even foods—like grapefruit juice, kale and fava beans—can interact with some medications.
  • St. John’s wort interacts with many medications and is especially a problem.
  • Tylenol should not be taken with alcohol, or after alcohol is consumed.
  • Poppers should not be taken with Viagra or other erectile dysfunction medications, since this can cause a dangerous drop in blood pressure.

Get rid of expired medications

Don’t take medications that have expired. Medications are rigorously tested to make sure that they’ll work until their expiration date. If you take medications past their expiration date they might not work, or, they might cause harm.

Some drugs, including antibiotics, can be toxic when taken after their expiration date.

More information on how to safely dispose of expired or unused medications can be found here. Unused, unneeded HIV medications can be donated to RAMP, a non-profit that gathers and delivers HIV medications to organizations overseas. Find out more about how to donate HIV medications here.

Advice on generic drugs versus brand name drugs

Dr. Sheran asked a question about generic drugs: Are they always exactly the same as the brand name version? Specifically, he said that a few of his patients had concerns about switching from Viramune XR to the generic version of the drug.

Lopez said that drug companies manufacturing generic versions of drugs have to prove that the drug they produce is the same, chemically, as the brand name version. Some companies, she said, actually produce the brand name and the generic version of a drug once the patent for the drug expires—and it’s exactly the same. However, depending on the generic, there are sometimes differences, especially with drugs that have a narrow therapeutic range, like levothyroxine (a thyroid medication).

Also, medication recalls do happen, said Lopez, when a drug is manufactured incorrectly or is producing unwanted side effects when it’s taken. It’s important for consumers to report differences they notice in how a generic drug affects them compared to the brand name drug to their care providers. People should also make sure they contact their care provider or pharmacist if they experience side effects from a drug that are new, unexpected or unfamiliar.

Write down all of your medications, and share this list with your health care providers

Ask your pharmacist or primary care provider if you plan on starting a new medication—even if you only plan on taking it every once in a while.

Get in the habit of writing down the names and doses of all of the medications you take, and taking that list with you when you see your health care providers. Keeping an up-to-date list of your medications is especially important if you see multiple health care providers that aren’t part of the same health care system. When people see specialists that aren’t in contact with each other, that’s when people have an increased risk of being prescribed medications that might interact with each other.

Positive Force is the go-to place for HIV-positive guys who live, work, or play in San Francisco who are looking for a community of HIV-positive men and non-positive allies. Get more info on how to get involved, and the next The Dr. Is In event by emailing pforce@sfaf.org.

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