title: Drug interactions between antiretrovirals and drugs used to treat benign prostatic hyperplasia/lower urinary tract symptoms.
abstract: BACKGROUND
  Significant advances in antiretroviral (ARV) therapy have transformed HIV into a chronic manageable disease. Co-morbidities associated with aging, such as benign prostatic hyperplasia (BPH), are becoming increasingly prevalent in the HIV-infected population. The pharmacological treatment of BPH involves medications mainly metabolized by CYP 450 enzymes, while many ARVs have inducing or inhibiting effects on the CYP 450 system. Consequently, there is potential for significant pharmacokinetic (PK) interactions between these two classes of medications.
  
  
  METHODS
  This article reviews the pharmacology and metabolism of selected BPH drug therapies and ARVs, in addition to highlighting potential interactions between these two drug categories. The authors also present PK evidence of interactions from available clinical trials, product monographs and international conference abstracts. Potentially significant drug interactions are summarized and strategies for management are discussed.
  
  
  CONCLUSIONS
  Drugs most likely to interact with BPH medications include protease inhibitors, the non-nucleoside reverse transcriptase inhibitors efavirenz, nevirapine, etravirine, and the cobicistat-boosted integrase inhibitor elvitegravir. Clinically significant PK interactions with BPH medications and dolutegravir, raltegravir, rilpivirine, or the investigational agent doravirine do not appear to exist. Clinicians working with HIV-infected individuals need to recognize the potential for interactions involving BPH and ARV treatments to ensure effective and safe drug therapy use.
authors.affiliation: a Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.|b Chronic Viral Illness Service, McGill University Health Centre , Montreal , Quebec , Canada.|c Immunodeficiency Clinic, Toronto General Hospital , University Health Network , Toronto , Ontario , Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Kreutzwiser
authors.affiliation: a Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada.|c Immunodeficiency Clinic, Toronto General Hospital , University Health Network , Toronto , Ontario , Canada.
authors.forename: Alice
authors.initials: A
authors.lastname: Tseng
mesh_terms: D000818:Animals; D019380:Anti-HIV Agents / Q000494:pharmacology*; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects / Q000378:metabolism; D004347:Drug Interactions; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D010599:Pharmacokinetics; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D003577:Cytochrome P-450 Enzyme System
keywords: 5α-reductase inhibitors; HIV; antiretrovirals; benign prostatic hyperplasia; drug interaction; geriatrics; lower urinary tract symptoms; pharmacokinetics; phosphodiesterase type 5 inhibitors; α1-Adrenergic antagonists