BCR-ABL Signaling Pathway raltegravir and midazolam may not require midazolam dosage adjustment

Gilead, ViiV Healthcare, Pfizer, Boehringher Ingelheim, and Tibotec. YY has received travel grants, consultancy fees and honoraria for presentations at workshops from Boehringer Ingelheim, Bristol Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck Sharp & Dohme Chibret, Pfizer, Roche, EPO906 Schering Plough, Tibotec and ViiV Healthcare.AED ARV administration may be indicated in up to 55% of people taking ARVs. Patients receiving phenytoin may require a lopinavir/ritonavir dosage rease of 50% to maintain unchanged serum concentrations . Patients receiving valproic acid may require a zidovudine dosage reduction to maintain unchanged serum zidovudine concentrations . Coadministration of valproic acid and efavirenz may not require efavirenz dosage adjustment .
Patients receiving ritonavir/atazanavir BCR-ABL Signaling Pathway may require a lamotrigine dosage rease of 50% to maintain unchanged lamotrigine serum concentrations . Coadministration of raltegravir/atazanavir and lamotrigine may not require lamotrigine dosage adjustment . Coadministration of raltegravir and midazolam may not require midazolam dosage adjustment . Patients may be counseled that it is unclear whether dosage adjustment is necessary when other AEDs and ARVs are combined . It may be important to avoid enzyme inducing AEDs in people on ARV regimens that lude protease inhibitors or nonnucleoside reverse transcriptase inhibitors, as pharmacokinetic interactions may result in virologic failure, which has clinical implications for disease progression and development of ARV resistance.
If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure efficacy of the ARV regimen .No formal antiepileptic drug treatment guidelines currently exist for individuals with HIV/ AIDS. ion milling Seizure disorders are common in individuals infected with HIV, with a reported idence as high as 11%; provoked seizures resulting from CNS opportunistic infections may also require AED treatment. 1–3 HIV/AIDS, especially prevalent in sub Saharan Africa, is becoming a chronic condition as antiretroviral therapies become reasingly available.4 The indications for AEDs have expanded to lude neurologic conditions other than epilepsy and psychiatric Potential interactions between ARVs and AEDs are complex and extensive.
Potential interactions of greatest concern relate to the P450 system enzyme induction effects of several older generation AEDs which might be expected to lower the effective dose of nonnucleotide reverse transcriptase inhibitors and protease inhibitors , which are also metabolized by the P450 system. But several additional potential mechanisms of interaction and the impact of ARVs on AEDs also warrant consideration. Effective HIV care requires lifelong treatment using regimens typically comprising at least 3 drugs.5 Many patients with HIV also require treatment for tuberculosis, which also ludes use of enzymeinducing medications.6–8 Specific guidelines for treating tuberculosis in the setting of HIV infection have been developed,9 yet none currently exists for AED ARV therapy. AED ARV interactions that raise blood levels of drugs in either class may rease toxicity risk. Use of ARVs that reduce AED levels could lead to loss of therapeutic AED effects, luding seizure.