Co-administration of a commonly used Zimbabwean herbal treatment (African potato) does not alter the pharmacokinetics of lopinavir/ritonavir

Abstract

Summary Objective African potato (Hypoxis obtusa) is commonly used in Sub-Saharan Africa as a complementary herbal remedy for HIV-infected patients. It is unknown whether or not co-administration of African potato alters the pharmacokinetics of protease inhibitor antiretrovirals. The objective of this study was to investigate the impact of the African potato on the steady-state pharmacokinetics of ritonavir-boosted lopinavir (LPV/r). Methods Sixteen adult volunteers were administered LPV/r 400/100 mg twice a day for 14 days, followed by concomitant administration with African potato given once daily for 7 days. Lopinavir plasma exposure as estimated by the area under the concentration–time curve over the 12-h dosing interval (AUC0–12h, AUCτ) was determined on day 14 and again on day 21. Lopinavir in plasma was analyzed using a validated liquid chromatography with tandem mass spectrometry (LC-MS/MS) method. Steady-state AUCτ and the maximum concentration following dose administration (Cmax) were determined using non-compartmental methods using WinNonlin Professional version 5.2.1. Statistical analyses were performed using Stata version 12.1. Results Co-administration of African potato was not associated with any change in lopinavir AUCτ, Cmax, or Ctrough. Conclusions African potato when taken concomitantly with LPV/r is well-tolerated and not associated with clinically significant changes in lopinavir pharmacokinetics.

Dietary supplement interactions with antiretrovirals: a systematic review

“…The supplements evaluated in these studies included African potato ( Hypoxis hemerocallidea or H. obtusa ), beta-carotene, Echinacea, fish oil, ginseng, goldenseal root, and Panax ginseng . 16–18, 21–23,25,26,28,29,30,32,33,35–38…”

Prediction of area under the concentration–time curve for lopinavir from peak or trough lopinavir concentrations in patients receiving lopinavir–ritonavir therapy

“…[1][2][3]6,11,[19][20][21][22] Since TDM is growing in popularity for all antiretroviral drugs, the premise of the study described here was that a lopinavir trough concentration value could predict the AUC in patients receiving a twice-daily regimen commonly used in practice. Because many of the pharmacokinetic studies also reported peak lopinavir concentrations, it was thought that peakdriven models for predicting the AUC could also be useful.…”

African potato (Hypoxis hemerocallidea): a systematic review of its chemistry, pharmacology and ethno medicinal properties

“…The effect on ritonavir was not analyzed in this study. Total cholesterol and triglycerides were elevated but within limits during LPV/r treatment [18]. The investigators concluded that African Potato had no significant effect on the steady-state pharmacokinetics of LPV.…”

“…[19] AUC area under the concentration-time curve within a dosing interval, BPH benign prostatic hyperplasia, BSS β-sitosterol, BSSG β-sitosterol glucoside, C max maximum concentration following dose administration, C trough plasma concentration at the end of the dosing interval, CL F apparent clearance, IPSS International Prostate Symptom Score, K el elimination rate constant, LPV/r ritonavir-boosted lopinavir, PTB pulmonary tuberculosis, T max time to reach C max , T 1/2half-life day was found to be therapeutic [19]. According to literature, an oral dose of 15 mg/ kg/ day is reportedly therapeutic [18]; however, it is unknown whether this dose is effective for all the claims against African Potato. Other sources state that 2400 mg taken daily is therapeutic [15].…”