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Herb-drug interaction between Echinacea purpurea and darunavir/ritonavir in HIV-infected patients

  • 1,
  • 2,
  • 1,
  • 3,
  • 1,
  • 4 and
  • 3
Journal of the International AIDS Society201013 (Suppl 4) :P187

https://doi.org/10.1186/1758-2652-13-S4-P187

  • Published:

Keywords

  • Public Health
  • Confidence Interval
  • Body Mass Index
  • Infectious Disease
  • Protease Inhibitor

Purpose of the study

To investigate the potential of a commonly used botanical supplement, Echinacea purpurea, to interact with the boosted protease inhibitor darunavir/ritonavir.

Methods

Open-label, fixed-sequence study in 15 HIV-infected patients receiving antiretroviral therapy including darunavir/ritonavir (600/100 mg twice daily) for at least 4 weeks. Echinacea purpurea root extract-containing capsules were added to the antiretroviral treatment (500 mg every 6 hours) from days 1 to 14. Darunavir concentrations in plasma were determined by using HPLC immediately before and 1, 2, 4, 6, 8, 10 and 12 hours after a morning dose of darunavir/ritonavir on days 0 (darunavir/ritonavir) and 14 (darunavir/ritonavir + echinacea). Individual darunavir pharmacokinetic parameters were calculated by using non-compartmental analysis, and were compared between days 0 and 14 by using the geometric mean ratio (GMR) and its 95% confidence interval (95% CI).

Results

Median (range) age was 49 (43-67) years, and body mass index was 24.2 (18.7-27.5) kg/m2. Echinacea was well tolerated and all participants completed the study. Relative to administration of darunavir/ritonavir alone, its coadministration with Echinacea purpurea resulted in little change in darunavir pharmacokinetic parameters. Table 1

Table 1

 

DRV/r

DRV/r + Echinacea

GMR (95% CI)

p

Cτ (ng/mL)

2.1 (1.6-2.7)

1.7 (1.4-2.2)

0.84 (0.59-1.19)

0.311

AUCτ (ng.h/mL)

46.2 (39.0-54.7)

41.6 (35.1-49.2)

0.90 (0.71-1.14)

0.374

Cmax (ng/mL)

6.4 (5.5-7.4)

6.2 (5.3-7.25)

0.98 (0.79-1.21)

0.810

Conclusions

coadministration of Echinacea purpurea with darunavir/ritonavir was safe and well tolerated in HIV-infected patients; data suggest that no dose adjustment for darunavir/ritonavir is necessary.

Authors’ Affiliations

(1)
Hospital Universitari Germans Trias i Pujol, “Lluita contra la Sida” Foundation, HIV Clinic, Badalona, Spain
(2)
Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, PK/PD modelling and simulation, Barcelona, Spain
(3)
Hospital Universitari Germans Trias i Pujol, "IrsiCaixa" Foundation, HIV Clinic, Badalona, Spain
(4)
Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Centre d'Investigació del Medicament, Barcelona, Spain

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