Drug-Drug Interactions with Antiretroviral Drugs in Pregnant Women Living with HIV: Are They Different from Non-Pregnant Individuals?
Por:
Bukkems, VE, Colbers, A, Marzolini, C, Molto, J and Burger, DM
Publicada:
1 oct 2020
Ahead of Print:
1 jul 2020
Resumen:
Background and Objective Although the separate effects of drug-drug interactions and pregnancy on antiretroviral drug pharmacokinetics have been widely studied and described, their combined effect is largely unknown. Physiological changes during pregnancy may change the extent or clinical relevance of a drug-drug interaction in a pregnant woman. This review aims to provide a detailed overview of the mechanisms, magnitude, and clinical significance of antiretroviral drug-drug interactions in pregnant women. Methods We performed a literature search and selected studies that compared the magnitude of drug-drug interactions with antiretroviral drugs in pregnant vs non-pregnant women. Results Forty-eight papers examining drug-drug interactions during pregnancy were selected, of which the majority focused on pharmacokinetic boosting. Other selected studies examined the drug-drug interactions between efavirenz and lumefantrine, efavirenz and tuberculosis drugs, etravirine and tenofovir disoproxil fumarate, atazanavir and tenofovir disoproxil, and mefloquine and nevirapine in pregnant compared to non-pregnant women. The clinical significance of antiretroviral drug-drug interactions changed during pregnancy from a minimal effect to a contra-indication. In almost all cases, the clinical significance of a drug-drug interaction was more relevant in pregnant women, owing to the combined effects of pregnancy-induced physiological changes and drug-drug interactions leading to a lower absolute drug exposure. Conclusions Multiple studies show that the clinical relevance of a drug-drug interaction can change during pregnancy. Unfortunately, many potential interactions have not been studied in pregnancy, which may place pregnant women living with human immunodeficiency virus and their newborns at risk.
Filiaciones:
Bukkems, VE:
Radboud Univ Nijmegen, Med Ctr, Dept Pharm, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands
Radboud Inst Hlth Sci RIHS, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands
Colbers, A:
Radboud Univ Nijmegen, Med Ctr, Dept Pharm, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands
Radboud Inst Hlth Sci RIHS, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands
Marzolini, C:
Univ Hosp Basel, Div Infect Dis & Hosp Epidemiol, Dept Med & Clin Res, Basel, Switzerland
Univ Basel, Basel, Switzerland
Univ Liverpool, Dept Mol & Clin Pharmacol, Liverpool, Merseyside, England
:
Fundacio Lluita Sida, Badalona, Spain
Hosp Badalona Germans Trias & Pujol, Infect Dis Dept, Badalona, Spain
Univ Autonoma Barcelona UAB, Barcelona, Spain
Burger, DM:
Radboud Univ Nijmegen, Med Ctr, Dept Pharm, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands
Radboud Inst Hlth Sci RIHS, Geert Grootepl Zuid 10, NL-6525 GA Nijmegen, Netherlands
hybrid, Green Published
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