Food, Drug, and Herb Interactions with Antiretroviral Drugs

Antiretoviral drugs can interact with food, with other drugs, and with commonly used herbal preparations. Patients are taught which of their drugs should be taken on an empty stomach, which should be taken with food, and specific foods that may affect drug effectiveness. It’s important for nurses to review instructions with patients, and to emphasize that if HIV drugs are not taken correctly with regard to meals, drugs may be up to 80% less effective. Even a short exposure to a suboptimal level of an HIV drug can lead to irreversible viral resistance, and significantly decrease the chance that the patient’s HIV infection can be controlled.

Drug-drug interactions are more common and potentially more severe with protease inhibitors than with other classes of antiretroviral drugs. Drug-drug interactions can reduce the effectiveness, and in some cases, can cause life-threatening reactions. There are many drugs that can reduce the effectiveness of antiretroviral drugs. Because some HIV drugs interfere with enzymes that normally metabolize drugs, the serum concentration of many other drugs can be increased.

Many individuals in the U.S. take herbal medicines. However, patients may not consider herbal remedies as "medicines" and may not think of telling their health care providers that they are taking them. Commonly used substances such as garlic supplements and St. John’s wort can affect the serum levels of some HIV drugs.

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It is vital that medications be taken correctly with regard to meals.