Date of report: 09 Oct 2019
Reported case interaction between
Raltegravir and Eslicabazepine
Raltegravir and Eslicabazepine
Drugs suspected to be involved in the DDI
Drug A
Raltegravir
(Victim)
Daily Dose
1200
(mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
July 9, 2018
End date
Ongoing
Drug B
Eslicabazepine
(Perpetrator)
Daily Dose
1200
(mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Oct. 1, 2014
End date
Ongoing
Complete list of drugs taken by the patient
Antiretroviral treatment
Raltegravir
Emtricitabine/Tenofovir-AF
Complete list of all comedications taken by the patient, included that involved in the DDI
Eslicarbazepine, paliperidone, mirtazapine, lorazepam, methadone.
Clinical case description
Gender
Male
Age
52
eGFR (mL/min)
>60
Liver function impairment
No
Description
52 year-old HIV-infected patient on treatment with raltegravir (1200 mg QD) plus FTC/TAF since July 2018. HCV co-infection, no liver function impairment. Paranoid schizophrenia and depressive syndrome on treatment with paliperidone, mirtazapine and lorazepam. Epilepsy with recurrent seizures despite treatment with different anticonvulsants (phenytoin, phenobarbital). On treatment with eslicarbazepine (1200 mg QD) since October 2014, with no subsequent seizures.
Despite potential decrease in raltegravir exposure due to mild UGT induction by eslicarbazepine, the patient maintains complete viral suppression (plasma viral load <40 copies/mL, October 2019).
Although it has not been studied, co-administration of eslicarbazepine with raltegravir might result in potential decrease in raltegravir concentrations and eventual failure of antiretroviral treatment. In cases without alternative options of effective antiretroviral and anticonvulsant therapy, there is a need for close monitoring of viral load.
Outcome
No unwanted outcome
Editorial Comment
In case of suspicion of a reduced exposure of raltegravir due to an increase of the viral load, therapeutic drug monitoring of raltegravir concentrations would be advisable.