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Effect of Carbamazepine on Darunavir Trough Concentrations: When the Dose Can Make the Difference-A Case Study.
- Source :
-
Therapeutic drug monitoring [Ther Drug Monit] 2024 Jun 01; Vol. 46 (3), pp. 277-280. Date of Electronic Publication: 2024 Apr 26. - Publication Year :
- 2024
-
Abstract
- Background: Carbamazepine (CBZ) is an antiseizure medication known to induce the expression of cytochrome P4503A metabolic enzymes. Here, we describe a man living with HIV who underwent several changes in the daily dose of CBZ, which resulted in different induction effects on darunavir trough concentrations.<br />Methods: A 59-year-old man with HIV, successfully undergoing maintenance antiretroviral treatment with darunavir/cobicistat once daily (combined with raltegravir), was prescribed CBZ for recurrent trigeminal neuralgia. Over subsequent months, the patient underwent various changes in the doses (from 200 to 800 mg/d) and trough concentrations (from 3.6 to 18.0 mg/L) of CBZ, guided by clinical response to trigeminal neuralgia.<br />Results: A highly significant inverse association was observed between darunavir trough concentration and both CBZ dose or trough concentration (coefficient of determination >0.75, P < 0.0001). Ultimately, the darunavir dose was increased to 600 mg twice daily with ritonavir and dolutegravir to ensure optimal antiretroviral coverage, anticipating potential further uptitration of CBZ doses.<br />Conclusions: The impact of CBZ on boosted darunavir exposure seemed to be dose- and concentration-dependent. The management of such drug-drug interactions in daily practice was facilitated through therapeutic drug monitoring. This case underscores the importance of a multidisciplinary approach that incorporates both antiretroviral and nonantiretroviral comedications contributing to the optimal management of polypharmacy in individuals living with HIV.<br />Competing Interests: The authors declare no conflict of interest.<br /> (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Subjects :
- Humans
Male
Middle Aged
Trigeminal Neuralgia drug therapy
Ritonavir therapeutic use
Ritonavir administration & dosage
Anticonvulsants pharmacokinetics
Anticonvulsants therapeutic use
Anticonvulsants administration & dosage
Pyridones pharmacokinetics
Pyridones therapeutic use
Pyridones blood
Heterocyclic Compounds, 3-Ring pharmacokinetics
Heterocyclic Compounds, 3-Ring therapeutic use
Heterocyclic Compounds, 3-Ring administration & dosage
Piperazines therapeutic use
Piperazines pharmacokinetics
Oxazines therapeutic use
Oxazines pharmacokinetics
Dose-Response Relationship, Drug
Anti-HIV Agents therapeutic use
Anti-HIV Agents pharmacokinetics
Anti-HIV Agents administration & dosage
Drug Monitoring methods
Darunavir therapeutic use
Darunavir pharmacokinetics
Carbamazepine therapeutic use
Carbamazepine pharmacokinetics
Drug Interactions
HIV Infections drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1536-3694
- Volume :
- 46
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Therapeutic drug monitoring
- Publication Type :
- Academic Journal
- Accession number :
- 38723113
- Full Text :
- https://doi.org/10.1097/FTD.0000000000001179