Date of report 27 Feb 2020
Reported case interaction between
Darunavir and Psyllium
Darunavir and Psyllium
Drugs suspected to be involved in the DDI-summary
Complete list of drugs taken by the patient
Gunabasic, lipidum
Clinical case description
HIV patient experiencing virologic rebound (mean HIV RNA: 80 copies/mL) after starting using two CAMs a few weeks before. Gunabasic, which is a taraxacum‐containing dietary supplement claimed to be a draining agent; and Lipidyum, which is a dietary supplement of phytosterols (mainly psyllium) recommended as a nonpharmacological approach to constipation, hypercholesterolemia, and overweight. The patient was enrolled in a clinical trial aimed at assessing the efficacy of a once‐daily fixed‐dose formulation containing tenofovir alafenamide, emtricitabine, darunavir, and cobicistat; no TDM data were available. Remarkably, HIV viral load, assessed a few weeks after discontinuation of the weight‐loss agents, returned to < 37 copies/mL. This case has been published by Cattaneo D, et al. in Obesity (Silver Spring). 2018 Aug;26(8):1251-1252.
Clinical Outcome
Drug Interaction Probability Scale (DIPS)
Editorial Comment
Weight-loss drugs should be used with caution in HIV-infected patients treated with antiretroviral drugs because of the risk of virologic failure. This episode could be related to psyllium, a soluble fiber from the husks of Plantago ovata that is able to increase stool weight and promote laxation; and is reported to decrease the absorption of calcium (Heaney RP, Weaver CM. Effect of psyllium on absorption of co‐ingested calcium. J Am Geriatr Soc 1995; 43: 261‐ 263)