Herbal products, recreational drugs and HIV meds

January 2011 View PDF Ask a question En español

Using HIV medicines with herbal products, supplements and recreational drugs can sometimes cause serious interactions. When taking HIV medicines, it’s wise to understand this issue to help you better manage your health. Because these types of interactions are not routinely studied, much of what we know comes from people reporting these reactions to their doctors and in ERs or from people in clinical studies.

Herbal supplements and HIV meds

Vitamins, supplements and herbs have long been used by people living with HIV to help manage the side effects of their regimens or improve their general health. In fact, studies suggest that about 2 out of 3 people with HIV and about half the general population use some form of complementary therapy. Unfortunately, not many of these have been studied in people with HIV.

Of the many herbal supplements available today, several interact with a few prescription drugs to some degree: echinacea, goldenseal, ginseng, vitamin E and fish oil. In some cases, there’s a known interaction and in others there’s a suspected interaction. How these apply to HIV meds are not fully understood.

Otherwise, other supplements do affect the blood levels of HIV meds, which may cause your HIV regimen not to work as well as it could. The most notable examples are St. John’s Wort, garlic supplements and perhaps milk thistle, which are generally discouraged when taking protease inhibitors and NNRTIs and perhaps any class of HIV drugs. The list on page 2 highlights these and other known interactions. Most results are from test tube studies that show these supplements may use the same protein in the liver that breaks down many HIV drugs.

Side effects from using herbs, vitamins and supplements may not reveal themselves immediately. It may take several weeks after starting a product for them to emerge. Keeping an accurate record of every therapy you take, including when you start and stop them, may help sort out which one is causing the problem.

This doesn’t mean to not use supplements at all, but to be aware of their possible interactions with HIV meds. You may want to speak to your doctor or pharmacist or trained nutritionist who can provide more information to avoid unnecessary interactions.

Recreational drugs and HIV meds

As for using HIV meds and recreational drugs such as GHB, heroin, ketamine and others, many have potentially severe drug interactions. These can include drug-induced hepatitis, heart attacks, paranoia, mania and death. A common example comes with the drugs used for erectile dysfunction (Viagra, Cialis, Levitra). Using any of these with protease inhibitors can potentially cause severe low blood pressure and death. For a full list of possible interactions, consult the AIDS Education Training Center’s publication, Recreational Drugs and HIV Antiretrovirals.

A little background

Under current law, vitamins, supplements and herbs do not have to be evaluated by any agency, like the Food and Drug Administration (FDA), to be sold to the public. As a result, these products can vary in how much of their active ingredient is present and even whether they contain other ingredients not listed on the label.

Those who promote supplements and herbs are often the first to criticize prescription drugs as the products of “big business.” However, supplements are themselves part of a huge industry — with annual sales of more than $20 billion.

People should be aware of these things and take measures to ensure they’re getting products from reliable sources. Talking to trained herbalists or nutritionists who specializes in HIV could help. Consulting with a publication like Consumer Reports and other groups like www.consumerlab.com, can also help.

Products and potential side effects

African wild potato	Test tube studies. Also called Hypoxis hemerocallidea.
Garlic supplements	Test tube studies. This may also be true of eating amounts of fresh garlic in place of store-bought products. Generally discouraged for protease inhibitors and NNRTIs, and perhaps other HIV drug classes.
Gingko biloba	A 2009 case study reported that a Dutch man’s HIV regimen (specifically Sustiva/efavirenz) failed due to an interaction with gingko biloba. This is only one case; however, the potential is there for this interaction and, perhaps, with other NNRTIs.
Grapefruit/juice	Can change how a drug is broken down in the gut. Eat or drink grapefruit products several hours after taking prescription meds.
Milk thistle	Test tube studies. Generally discouraged. Also called Silybum marianum.
Psyllium	And other bulking laxatives may affect the absorption of prescription drugs. Generally should be taken several hours after taking prescription meds.
St. John’s Wort	This herb can greatly alter the blood levels of HIV drugs. Generally discouraged for protease inhibitors and NNRTIs, and perhaps other HIV drug classes. Also called Hypericum perforatum.
Sutherlandia	Test tube studies. Also called Sutherlandia frutescens.