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Garlic use can lower levels of HIV protease inhibitor saquinavir

Anthony J. Brown, MD

WESTPORT, CT (Reuters Health) – HIV-infected patients receiving saquinavir should probably not use garlic supplements. A report in the January 15th issue of Clinical Infectious Diseases indicates that plasma levels of the protease inhibitor decrease significantly when garlic supplements are used.

Dr. Judith Falloon, from the National Institutes of Health in Bethesda, Maryland, and colleagues assessed the effect of garlic supplements on the pharmacokinetics of saquinavir in 10 healthy volunteers.

When garlic was given, the mean area under the curve for saquinavir decreased by 51% over the 8-hour dosing interval, the authors state. In addition, trough saquinavir levels at 8 hours decreased by 49% and mean maximum concentrations decreased by 54%. Even after a washout period of 10 days these values only returned to 60% to 70% of baseline values.

"For HIV-infected patients, drug levels are very important, so it is critical to understand the effects of herbal therapies on these levels," Dr. Falloon told Reuters Health. "Garlic is a commonly used supplement…and we studied saquinavir because we thought it was most likely to show an interaction with garlic," she added.

"Garlic supplements significantly affected saquinavir levels," Dr. Falloon noted. "The simple message is that if you are taking saquinavir as part of an antiretroviral regimen you shouldn't be using garlic supplements," she said. "The broader message is that a number of interactions like this probably occur that we are unaware of," she added.

"My guess is that a boosted regimen would probably solve the problem of a lower saquinavir level, but we didn't study that," Dr. Falloon noted. Also, "it is hard to know whether a similar effect would be seen with other protease inhibitors or different garlic supplements."

Clin Infect Dis 2002:34:000-000.

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