The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

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A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 27: Pharmacologic Interactions of Clinical SignificanceEffects of Concomitant Medications on QTC ProlongationTorsades des pointes is a serious form of cardiac arrhythmias which has been associated withreports of sudden death within the last several years. Like many other drugs, several of themedications reported to cause torsades des pointes are metabolized by CYP3A, a specific memberof the cytochrome P450 enzyme system responsible for a larger percentage of these degradationreactions. Tables 27-6a and 27-6b (above) offer clinical monitoring parameters as well asbaseline counseling tips for patients receiving such drugs.Table 27-7 highlights HIV-related drugs with overlapping toxicities. Table 27-8 lists some of themost significant drug interactions with agents used in the treatment of Pneumocystis carinipneumonia, 10 the most common opportunistic infection at the point of AIDS diagnosis for mostpatients with HIV disease.Table 27-7: HIV-related Drugs with Overlapping Toxicities*Drugs that causebone marrow suppressionDrugs that cause nephrotoxicityDrugs that cause pancreatitisDrugs that cause hepatotoxicityCidofovirCancer chemotherapyDapsoneFlucytosineGanciclovirHydroxyureaInterferon-aPentamidinePyrimethamineRibavirinSulfadiazineTrimethoprim-sulfamethoxazole (high doses)Trimetrexate (high doses)ZidovadineAdefovir ( now removed from clinical trials)AminoglycosidesAmphotericinFoscarnetIndinavirPentamidineCotrimoxazole**DidanosineEthanolLamivudine (in children)PentamidineValproic acidDelavirdineEfavirenzFluconazoleIsoniazid562U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 27: Pharmacologic Interactions of Clinical SignificanceTable 27-7: HIV-related Drugs with Overlapping Toxicities* (continued)Drugs that cause hepatotoxicitycontinued26 picasDrugs that cause rashwith or without pruritisDrugs that cause diarrheaDrugs that cause ocular toxicityDrugs to avoid in patientswith peripheral neuropathyKetoconazoleNevirapineNNRTIsPIsRifabutinRifampinAmprenavirAbacavirCotrimoxazoleDapsoneNNRTIsClindamycinDidanosineLopinavir/ritonavirNelfinavirRitonavirSaquinvirCidofovirEthambutolIsoniazid (optic neuritis and optic atrophy)Lamivudine (uveitis in children)RifabutinSingle-ingredient DrugsDidanosineNitrofurantoin (oral)Nitrofurantoin macrocrystal (oral)Nitrofurantoin sodium injectionStavudineZalcitabineMultiple-ingredient DrugsDidanosine/calcium carbonate/magnesium salt (oral)Didanosine/magnesium salt/sodium citrate (oral)Nitrofurantoin/hexylresorcinols/cetrimonium (oral)Nitrofurantoin/nitrofurantoin macrocrystal (oral)Nitrofurantoin/pyridoxine HCL (oral)Nitrofurantoin/tetracaine (oral)Sulfadiazine/nitrofurantoin (oral)Sulfadiazine/nitrofurantoin/phenazopyridine (oral)Sulfamethizole/nitrofurantoin (oral)* Concomitant administration of agents not recommended; if unavoidable, close clinical monitoring suggested.** Cotrimoxazole causes a 40% increase in the plasma concentrations of lamivudine and so may increase lamivudine toxicity such asheadaches, myalgia and neutropenia. Monitor closely upon concomitant use.XXVIIU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 563
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DedicationA Clinical Guide to Suppo
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Lynn A Jansen, RN, PhDAssistant Res
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TABLE OF CONTENTSPart IChapter 1Cha
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IChapter 1.26 picasHIV and Palliati
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IA Clinical Guide to Supportive and
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A Clinical Guide to Supportive and
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IIIChapter 3.Assessment of Physical
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Chapter 6.26 picasPulmonary Symptom
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Chapter 8.26 picasOral ProblemsDavi
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Chapter 9.26 picasDermatologic Prob
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Chapter 10.26 picasPsychiatric Prob
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Chapter 11.26 picas Substance Use P
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Chapter 14.26 picasCulture and Care
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Chapter 15.26 picasSpecial Populati
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Chapter 17.26 picasEthical IssuesLy
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Chapter 18.26 picasLegal and Financ
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Chapter 19.Palliative 26 picas Care
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Chapter 25.26 picas Prevention of S
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