Date of report: 16 May 2019
Reported case interaction between
 Darunavir and Tejocote Root (Crataegus Mexicana Or Crataegus Pubescens)

FLS Science

Drugs suspected to be involved in the DDI

Drug A
Darunavir (Victim)
Daily Dose
800 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
May 17, 2016
End date
Ongoing
Drug B
Tejocote Root (Crataegus Mexicana Or Crataegus Pubescens) (Perpetrator)
Daily Dose
Unknown
Dose adjustment performed
No
Administration Route
Oral
Start date
Unknown
End date
Ongoing

Complete list of drugs taken by the patient

Antiretroviral treatment
Darunavir/Cobicistat
Dolutegravir
Complete list of all comedications taken by the patient, included that involved in the DDI
Tejocote root (Crataegus mexicana or Crataegus pubescens), Diclofenac

Clinical case description

Gender
Male
Age
49
eGFR (mL/min)
>60
Liver function impairment
No
Description
Patient taking Tejocote root (Crataegus mexicana or Crataegus pubescens) to loose weight. Cratageus mexicana can inhibit UGT, increasing concentrations of drugs metabolized through this pathway. It may also induce CYP3A4, potentially decreasing concentrations of drugs metabolized trough this pathway. Furthermore, it has alcaloids with similar structure to digoxin, so it could interfere in its pharmacodynamic action (Source: Memorial Sloan Kettering Cancer Center database) The patient had detectable viral load, but without selecting resistance mutations. This could be due to irregular adherence and/or to the high genetic barrier of both drugs in the regimen.

Outcome

Loss of efficacy

Drug Interaction Probability Scale (DIPS)

Score
2 - Possible

Editorial Comment

Cratageus mexicana can inhibit UGT, increasing concentrations of drugs metabolized through this pathway. It may also induce CYP3A4, potentially decreasing concentrations of drugs metabolized trough this pathway. Furthermore, it has alcaloids with similar structure to digoxin, so it could interfere in its pharmacodynamic action (Source: Memorial Sloan Kettering Cancer Center database)