What's Safe on PrEP?

Pharmacist Drew shares what medications and herbal products can interact with PrEP

What Not to Mix

Did you know something common in our medicine cabinets might not be safe while on PrEP?

Anti-inflammatories like ibuprofen (Advil) and naproxen (Aleve) can affect our kidneys and this risk may be increased while taking PrEP.

Generally, rare occasional use of anti-inflammatories while on PrEP should be okay in individuals in general good health (eg. a person goes in for dental work and takes a day or two of them). However, more frequent or regular use is not typically recommended and should be closely monitored if being taken together. Acetaminophen (Tylenol) is usually preferred for pain and fever. 

In general, changes in kidney function are quite rare on PrEP and are not anticipated. If you are being monitored properly according to Canadian guidelines you will be getting lab work to check this every 3 months. 

If changes are to happen, they would generally occur over time and would get caught on lab work. If more significant changes were to happen the medication can be stopped and typically changes are reversible. 

What else should I know about?

Not Expected to Interact
With PrEP

This information is for
educational purposes only.
  • MDMA / Molly / Ecstasy, cocaine, crystal meth
  • ED Meds (eg. Viagra, Cialis)*
  • Cannabis
  • Alcohol
  • Poppers

Not Recommended
While on PrEP

Speak to your care provider about the
appropriateness of combing these.
  • Ongoing or regular anti-inflammatory use
  • Some anti-seizure medication*
  • Some prescription antifungals*
  • St John's Wort*

Do you have questions about getting the COVID Vaccine while on PrEP?

Here's what we know.

We are not aware of any safety concerns between PrEP and COVID vaccination. Many patients have reached out to us about this before, so we knew it’s important to provide the answer for everyone.

 

At this time, the only consideration you should know about is to space out any other vaccines by at least 28 days. So, if you wanted to start Hep A/B or HPV vaccinations (or are due for your next dose) you would need to wait if you recently got the COVID vaccine or plan to get it soon.

In the absence of clear studies – which will be the case for most medication and the COVID vaccine (or most medication and any vaccine really) – as a Certified HIV Pharmacist I consider if any interactions would be predicted.

 

I look at things like how each is absorbed, metabolized, distributed, or eliminated in the body. Taking this into account I would not anticipate an unsafe interaction. Some patients thought there could be an interaction due to changes in immunity etc – but PrEP does not affect the immune system – it just acts to block HIV directly while the medicine is in our body. 

What we do have actual experience in is people living with HIV receiving the COVID vaccines. Many people on HIV treatment are on regimens that include the drug ingredients in PrEP as part of their treatment combo. Case reports are showing a good immune response to the vaccine in these patients. We are not encouraging patients to discontinue PrEP if getting the vaccine. 

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Hey Pharmacist Drew! Can I take supplements while on PrEP?

Many supplements can be combined safely with PrEP. However, it is important to let your care provider know if you will be taking creatine or protein supplements. While generally safe, these may affect the results from routine PrEP lab test results.

One of the regular blood tests while on PrEP measures the level of creatinine in your blood and provides an estimate of how well things are clearing from the kidneys. This is known as the eGFR (estimated glomerular filtration rate). Supplements can potentially make it appear your kidneys are not clearing things as well, even when they are working normally.

Always let whoever is prescribing and monitoring your PrEP medication know what you are taking so they can best interpret lab results.

What Not to Mix with Descovy

 If you’re taking the newer formulation of PrEP (Descovy) you should also be aware that the common herbal product St. John’s Wort should not be combined with it. This herbal is sometimes used for mild to moderate depression but when combined with PrEP may decrease its ability to protect against HIV. Some data suggests lower strengths of St. John’s Wort may be okay, but generally it is not recommended. If your care provider has started you on this you should follow-up with them.

In terms of prescription medication, some seizure medications and antifungals are not safe to take with this version of PrEP. It is important to always let your pharmacist know if you are starting a new herbal product, over the counter medication, or prescription medication. If they are not familiar with HIV medications we are accessible 7 days a week at 416-420-1250.

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