Recreational Drugs: Amyl Nitrate, Amphetamines, Cannabis, Cocaine/Crack, Ghb, Hallucinogens, Ketamine, Heroin, Naloxone

RECREATIONAL DRUGS: AMYL NITRATE, AMPHETAMINES, CANNABIS, COCAINE/CRACK, GHB, HALLUCINOGENS, KETAMINE, HEROIN, NALOXONE

INSTIs NNRTIs PIs

xBICTEGRAVIR (Biktarvy) xELVITEGRAVIR/ x DORAVIRINE (Pifeltro, x EFAVIRENZ (Sustiva, Boosted with ritonavir xDOLUTEGRAVIR (Tivicay, COBICISTAT (Stribild, Delstrigo) Atripla) (Norvir) or cobicistat Triumeq, Juluca) Genvoya) x RILPIVIRINE (Edurant, x ETRAVIRINE (Intelence) xATAZANAVIR (Reyataz, xRALTEGRAVIR Complera, Odefsey, x NEVIRAPINE Evotaz) (Isentress) Juluca) (Viramune) xDARUNAVIR (Prezista, Prezcobix, Symtuza) xLOPINAVIR (Kaletra) AMYL NITRATE

xPoppers, ames

AMPHETAMINES

xMDMA/ecstasy, Potential for n Potential for n recreational crystal, molly recreational drug drug

CANNABIS

xMarijuana, weed

COCAINE

xcrack, base, Potential for n Potential QT prolongation Potential for n levels of Potential for n recreational recreational drug (rilpivirine) hepatotoxic metabolite drug

GAMMA -HYDROXYBUTYRATE

xGHB, date rape Potential for n Potential for n recreational drug, Geeb, liquid recreational drug drug X

RECREATIONAL DRUGS INSTIs NNRTIs PIs

HALLUCINOGENS xLSD, acid Potential for n WŽƚĞŶƚŝĂůĨŽƌљ Potential for n recreational xPCP, angel dust recreational drug recreational drug drug KETAMINE xSpecial K, vitamin Potential for n WŽƚĞŶƚŝĂůĨŽƌљ Potential for n recreational K, KitKat recreational drug recreational drug drug

HEROIN xSmack, H, tar, junk Potential for n WŽƚĞŶƚŝĂůĨŽƌљ morphine Potential for n recreational recreational drug (converted from heroin) drug with efavirenz

NALOXONE xNarcan Ritonavir-boosted PIs: ƉŽƚĞŶƚŝĂůĨŽƌљŶĂůŽǆŽŶĞ Cobicistat-boosted PIs

Legend: No dose adjustment required.

Use combination with caution. Adjustment in drug dose or frequency or additional/more frequent monitoring may be required. May wish to

consult with a pharmacist knowledgeable in HIV drug interactions. Contraindicated/avoid combination.

RECREATIONAL DRUGS Mechanism of Drug Interactions, Management and Monitoring

Class Mechanism of Interaction Main Interacting ARVs Management Monitoring Stimulants: Inhibition of Protease Inhibitors (PI) (with Warn patient of potential for Toxicity: Cocaine, amphetamines CYP3A4(cocaine) and CYP ritonavir or cobicistat) & unpredictable increased Dehydration, dry mouth, 2D6 (amphetamines, GHB?) Elvitegravir/cobicistat levels of the recreational teeth grinding, tense jaw, GHB leading to increased levels of substance and provide harm tachycardia. stimulant reduction advice GHB: seizures, bradycardia, loss or consciousness Hallucinogens: Mechanism unclear but PIs & elvitegravir/cobicistat Warn patient of Toxicity: LSD, PCP (angel dust) potential for inhibition or may increase hallucinogen unpredictable increased Hallucinations, psychosis, induction of drug concentrations levels of hallucinogen and flashbacks, seizures, metabolism Enzme inducing NNRTIs provide harm reduction hypertension. (efavirenz, etravirine, advice nevirapine) may decrease levels Ketamine Mechanism unclear but PIs & elvitegravir/cobicistat Warn patient of Toxicity: potential for inhibition or may increase ketamine unpredictable increased Nausea, vomiting, SOB, loss induction of drug Enzyme inducing NNRTIs levels and provide harm of coordination, cognitive metabolism (efavirenz, etravirine, reduction advice decline nevirapine) may decrease levels Heroin Converted to morphine, PIs & elvitegravir/cobicistat Warn patient of Toxicity: decreased level of which is glucuronidated may increase morphine unpredictable increased consciousness, miosis, (UGT2B7>UGT1A1) and a Efavirenz may induce UGT levels and provide harm respiratory depression. substrate of Pgp and decrease morphine reduction advice Acute symptoms may be reversed with naloxone. Naloxone Substrate of UGT2B7 Ritonavir-boosted PIs may Potential for decreased Monitor for duration of induce UGT and decrease duration of naloxone naloxone efficacy. naloxone efficacy

RECREATIONAL DRUGS ô+ , %#+#,2ô2--*ô$-0 '«5 "03%̞"03%ô',2#0 !2'-,1

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