PPI and HIV meds

 Q: 64 years old male on HIV therapy is admitted to ICU after a motor vehicle accident. General ICU orders are executed including Proton-Pump Inhibitors (PPIs) for GI prophylaxis. PPIs? (select one)

A) potentiates protease inhibitors action

B) compromises protease inhibitors action

Answer: B

There are three categories where PPIs should be used with caution: 

• Clopidogrel - PPIs compromises it's action 
• HIV protease inhibitors - PPIs compromise their action 
• Methotrexate - PPIs potentiates its action 

PPIs compromise the action of protease inhibitors by decreasing their absorption particularly rilpivirine and atazanavir.

#pharmacology

References:

1. FDA's MedWatch Safety Alerts: November 2009. Plavix and Prilosec Drug Interaction. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm192103.htm#PlavixandPrilosecDrugInteraction (Accessed on January 26, 2009). 

2. Wedemeyer RS, Blume H. Pharmacokinetic drug interaction profiles of proton pump inhibitors: an update. Drug Saf. 2014 Apr;37(4):201-11. doi: 10.1007/s40264-014-0144-0. PMID: 24550106; PMCID: PMC3975086. 

3. Béïque L, Giguère P, la Porte C, Angel J. Interactions between protease inhibitors and acid-reducing agents: a systematic review. HIV Med. 2007 Sep;8(6):335-45. doi: 10.1111/j.1468-1293.2007.00482.x. PMID: 17661841. 

4. Suzuki K, Doki K, Homma M, Tamaki H, Hori S, Ohtani H, Sawada Y, Kohda Y. Co-administration of proton pump inhibitors delays elimination of plasma methotrexate in high-dose methotrexate therapy. Br J Clin Pharmacol. 2009 Jan;67(1):44-9. doi: 10.1111/j.1365-2125.2008.03303.x. Epub 2008 Nov 17. PMID: 19076159; PMCID: PMC2668083.