Protease inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTIs), and elvitegravir were most likely to interact with medications used to treat benign prostatic hypertrophy (BPH), a review article in Expert Opinion on Drug Metabolism & Toxicology reported.

Among an aging HIV-infected population, comorbidities such as BPH are growing more prevalent. The usual pharmacological treatment for BPH involves drugs primarily metabolized by CYP450 enzymes while many antiretroviral agents have inhibiting or inducing effects on the CYP450 system. As a result, potentially significant pharmacokinetic interactions between these medication classes can exist. 

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Study authors Denise Kreutzwiser and Alice Tseng of the University Health Network, Toronto, Canada, reviewed the pharmacology and metabolism of select BPH medications and antiretrovirals. They also highlighted possible interactions between these drug classes and presented evidence of interactions from existing clinical studies, drug monographs, and international conference abstracts. 

Kreutzwiser and Tseng found that the drugs most likely to interact with BPH medications were protease inhibitors, NNRTIs (eg, efavirenz, nevirapine, etravirine), and the cobicistat-boosted integrase inhibitor elvitegravir. No clinically significant pharmacokinetic interactions between BPH medications and dolutegravir, raltegravir, rilpivirine, or doravirine (an investigational agent) were noted

Healthcare providers working with HIV-infected patients should be aware of the potential interactions between BPH and antiretroviral treatments to ensure safety and efficacy.

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