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Author Topic: Recreational drugs  (Read 2777 times)

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Offline G-Irish

  • New Member
  • Posts: 2
Recreational drugs
« on: December 21, 2015, 05:08:58 pm »
I've read up some material online about the dangers of drug interactions between the meds and some recreational drugs. I was just wondering if anyone has any experience/advice with this? Specifically with kivexa/darunavir/Ritonavir combo and ecstasy?

Offline Mightysure

  • Member
  • Posts: 449
Re: Recreational drugs
« Reply #1 on: December 21, 2015, 08:01:31 pm »
"interactions" is a loaded term.  It could mean that certain drugs increase the bioavialablity of others,  decrease it or mix to create harmful combos or harmful physiological reactions.  It would take some research into contraindications of drugs but I honestly don't think anyone is gonna give you advice on how to use extasy with hiv meds.

Offline harleymc

  • Member
  • Posts: 1,524
Re: Recreational drugs
« Reply #2 on: December 27, 2015, 10:16:45 pm »
It's been about 4 years since I've had an Eccy, back then I would have been on Kivexa with Ritonovir as a booster.
I had a good night.

With street drugs you take your chances as to what is actually in that pill or powder there are no guarantees.

Offline oksikoko

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  • Posts: 690
  • Writing the congressman again
Re: Recreational drugs
« Reply #3 on: January 17, 2016, 12:33:20 pm »
Information on the effects of so-called "recreational" drugs on antiretrovirals can be found,  but much of it stinks of biases of its sources,  be they pro- or anti- drug.  You may get  lot of anecdotal advice,  but take that with the proverbial grain of salt, or dram of GHB if you prefer,  unless disinterested research can back up the personal stories. For instance,  it has been noted anecdotally that those taking cobicistat felt the effects of certain drugs for inordinate lengths of time. Lo and behold, a bit of research reveals cobicistat suppresses a liver enzyme called CYP3A4. This enzyme, and other such CYP- enzymes, is responsible for clearing many drugs from the blood,  including the integrase inhibitor elvitegravir.  Suppress CYP3A4 and you thereby increase the level of elvitegravir floating around in your body.  Unfortunately or fortunately depending upon your view of being a cheap date,  the pharmacokinetic enhancing (ie liver suppressing) abilities of little cobicistat also interfere with the clearance of several other drugs from the system,  notably caffeine and crystal meth amphetamines. A person on cobicistat,  therefore,  requires less coffee than a normal person to feel perky all day.  With reduced clearance of drugs from the system comes increased risk of overdose,  though fortunately both caffeine and meth have relatively low (direct) toxicities even at fairly high doses. However,  the incidental effects of being tweaked on caffeine or method three times longer than the average person can be problematic at any dose.

How does this relate to your specific question? It turns out that though ritonavir,  unlike cobicistat,  has antiretroviral properties on its own,  it is also added to other cocktails as a pharmacokinetic (nice way of saying 'liver suppressing') enhancer.  It does this by suppressing another CYP- enzyme,  CYP2D6. As luck (or misfortune) would have it,  MDMA (for our purposes,  this is ecstasy) is metabolized by a range of CYP- enzymes,  notably CYP2D6. What does this mean? In theory,  you could get a functionally larger dose than everyone around you taking the same pill or capsule. That may sound like a good time except that overdose on ecstasy is not an unheard of event.  In the references noted below,  at least one death has been attributed to taking ecstasy while on ritonavir. Of course, a certain number of people overdose every year from most any drug,  and if you're willing to take that risk against those odds in general,  one possible overdose death attributed to ritonavir combined with ecstasy will probably not sway your thinking.

Whatever you decide to do,  just keep in mind that you may get a stronger effect than those around you,  stay hydrated and pace yourself. I'm not a doctor, and I'm not even particularly bright, so talk to a medical professional before making up your mind. I've presented a very simplified view of the info you'd need to begin a risk assessment,  but as you can see in the third link,  it's all much more complicated than this, with such seemingly unrelated factors as your race affecting the probability and magnitude of drug interactions.

1. https://www.erowid.org/psychoactives/health/health_article1.pdf

2. http://www.aidsinfonet.org/fact_sheets/view/494

EXCERPT
Ecstasy/MDMA
Ecstasy uses the same liver pathway as protease inhibitors. This can cause very high levels of ecstasy in the body of people taking protease inhibitors. There is one documented case report of a death due to an interaction between ecstasy and ritonavir. Ecstasy can also increase the risk of kidney stones when used with indinavir (Crixivan, fact sheet 441) due to dehydration.

3. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-medicine/preventing-toxic-drug-interactions-and-exposures/

EXCERPT
Protease Inhibitors
Significant interactions occur with saquinavir, ritonavir, indinavir, and nelfinavir, all of which inhibit CYP3A4 isoenzyme. Ritonavir also inhibits CYP2D6 and reduces the clearance of medications metabolized by that isoenzyme, including benzodiazepines, calcium channel blockers, antidepressants, antiarrhythmics, corticosteroids, anticoagulants, opiates, and clarithromycin.

Code: [Select]
2014-11-14: CD4 Wars Episode II: Return of the Stribild (released in Europe as Stribild II: Werewolf Bitch)
2014-11-06:                ☣ VL (→) 12,627      ☣ CD4 (→) 639
2014-??-??: off treatment  ☣ VL (?)              ☣ CD4 (?)
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
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