MedPage Today (01/04/12) Smith, Michael
Recently published in the Jan. 10 issue of Neurology, a report by Gretchen Birbeck of Michigan State University and colleagues, shows some evidence that drug-on-drug interactions could occur when anti-epileptic medications are combined with anti-HIV medications. The report authors noted the lack of guidelines to help doctors make drug choice in such situations and the American Academy of Neurology and the International League Against Epilepsy gathered an international panel to use evidence for the creation of a guideline. The panel discovered in their efforts that only 42 articles provided data on Class II and II studies that could only result in level C, or 'possibly valid' recommendations. The panel noted that there was substantial concurrent use of both anti-HIV and anti-epilepsy medications, and that some medication combinations would need dosage adjustments to maintain proper concentrations. The panel also noted that avoiding enzyme-inducing anti-epileptics for those with HIV regimens including protease inhibitors or non-nucleoside reverse transcriptase inhibitors could be wise, as these drug classes use the cytochrome P450 system and interactions could cause virologic failure which can have implications on disease progression and resistance.