Anti-HIV Medications + Street Drugs: Some
Cocktails Don't Mix
Reprinted from Notes from the Underground Winter 1998-99, #38.
For most drugs to be effective and not kill you, they need to be metabolised
[broken down] by the liver or kidneys. These organs have limited resources and a
set number of chemicals which accomplish this task. Because of this, certain
drugs, whether they're HIV medications or recreational drugs, can affect how
other drugs act. This is called a drug interaction— and some of them can be
There hasn't been much research on how street drugs and HIV medications
interact—because there is little financial incentive for the pharmaceutical
companies to do the work, and because the government believes "just say no,"
is the only way to deal with drugs. Certainly, your best bet is not to take street
drugs at all if you are taking HIV medications. But some interactions are
deadlier than others.
|Ecstasy (X, MDMA) |
There has already been one death in England which resulted from a regular dose
of ecstasy (MDMA, X) taken with Norvir (ritonavir). Norvir acts to slow down the
liver enzyme that breaks down X—so it makes the dose 5 to 10 times stronger.
In addition, between 3-10% of the white population (the figure for other
populations is not known) have a deficiency in this enzyme, which may be why
some people overdose on what may be a safe dose for others. If you are taking
any protease inhibitor [ritonavir (Norvir), nelfinavir (Viracept), indinavir (Crixivan)
saquinavir (Fortovase)] or non-nucleoside reverse transcriptase inhibitor
nevirapine (Viramune) delavirdine (Rescriptor) or efavirenz (Sustiva)], X can be
extremely dangerous. Of these, Norvir and Rescriptor seem to be the most
dangerous, while Viramune and Sustiva may be less so—although because
effects in the test tube have sometimes been opposite to those seen in the body,
this is hard to predict.
If you do take X with a protease inhibitor, wait as long as possible after taking the
protease inhibitor to take the X, and be sure to have someone with you who
knows what you've done in case you have difficulties. These overdoses are often
not reversible, so it's really better not to mix these drugs!
Recent research has found that X damages serotonin neurons, so avoid it if you
have a family or personal history of depression or anxiety disorders.
Videx (ddI) can increase the risk of pancreatitis (intense stomach pain that feels
like it's going all the way through to your back. So, if you're using alcohol
regularly, don't use Videx. There are other nucleosides to choose from.
Occasional and light use of alcohol is not known to interact with other HIV
medications; however, chronic, heavy use can be destructive to the liver. This
can be dangerous because the way drugs are broken down can be hurt. More
drugs will stay in your system for the most part, which is likely to cause overdoses
and worse side effects. Alcohol can cause dehydration; so be sure to drink lots
of water to help your body deal with any alcohol you drink.
Protease inhibitors may increase THC levels (the active ingredient in
marijuana)—so smaller doses may make you more stoned. This is also true of
the synthetic version (Marinol) used in the treatment of weight loss. Since THC
overdose is impossible, this interaction is not dangerous.
The sedatives Halcion (triazolam), Valium (diazepam), Ambiem (zolpidem) and
Versed (midazolam) can also be deadly if mixed with protease inhibitors. Norvir
has the largest negative effect. At high doses these drugs can stop your
breathing. Ativan (lorazepam), Serax (oxazepam) and Restoril (temazepam) are
safer with Norvir, and may actually be weakened by it.
Crixivan may increase blood levels of phenobarbital (Luminal), making overdose
more likely. Other protease inhibitor interactions are also possible.
|Cocaine (coke, blow) |
There are no known interactions between cocaine and HIV medications, but in
the test tube, cocaine doubles the speed at which the virus reproduces, meaning
it may speed up how sick you get.
|Heroin (smack, brown, junk, China White) |
Norvir seems to reduce heroin levels by 50% making overdose less likely.
However, this drug and the other protease inhibitors have sometimes been
known to have opposite effects (they cut methadone levels in real life, while test
tube experiments predicted they would increase them), so caution is in order.
Some synthetics sold as heroin (fentanyl, alpha-methyl-fentanyl) are potent in tiny
doses and could be deadly if mixed with another drug.
|GHB (gamma-hydroxy-butyrate, grievous bodily harm, liquid X) |
GHB is potentially dangerous with Norvir and other protease inhibitors.
|Amyl nitrite (amyl nitrate/poppers) |
Glutathione is used by the liver to process amyl nitrite, and high glutathione is
linked with survival. If using amyl nitrite cuts glutathione, it could lead to disease
|LSD (acid) |
No known interactions.
|Amphetamines (dexedrine, amphetamine, methamphetamine, crystal
Norvir is predicted to increase amphetamine levels in the blood by a factor of
2-3. The other protease inhibitors should have less of an impact, but strange
opposite results are always possible.
Norvir and other similar drugs can either strengthen Ritalin's effects or make it
Interactions not listed could be deadly. Street drugs are often not what they are
sold as, they are frequently cut with substances that may interact with drugs
themselves and their potency can vary wildly, even in the same batch. With the
lack of research in this area, it's better to avoid potential interactions if at all
Mocht je na het lezen van deze brochure nog vragen hebben, stel ze gerust tijdens de raadpleging!
Dr. Patrick Sweetlove,
Osystraat 41, 2060 Antwerpen
Raadpleging enkel na afspraak op: 03 / 225 24 25.
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