Didanosine

Also indexed as: ddI, Dideoxyinosine, Videx®

Didanosine is a drug that blocks reproduction of the human immunodeficiency virus (HIV). HIV is the virus that infects people causing acquired immunodeficiency syndrome (AIDS). Didanosine is used in combination with other drugs to treat HIV infection.

Summary of Interactions with Vitamins, Herbs, and Foods
(for details about the summarized interactions, read the full article)

Beneficial May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Acetyl-L-Carnitine
Beneficial May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Acetyl-L-Carnitine

Riboflavin
Beneficial May be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.

Shiitake*
Reduced drug absorption/bioavailability

None known
Adverse interaction

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Riboflavin
Persons with AIDS have developed lactic acidosis and fatty liver while taking didanosine and other drugs in its class. Didanosine can inhibit crucial DNA-related riboflavin activity, which may be normalized by riboflavin supplementation. A 46-year-old woman with AIDS and lactic acidosis received a single dose of 50 mg of riboflavin, after which her laboratory tests returned to normal and her lactic acidosis was completely resolved.1 More research is needed to confirm the value of riboflavin for preventing and treating this side effect.

Acetyl-L-Carnitine
Severe peripheral neuropathy (painful sensations due to nerve damage in the hands and feet) often develops in people taking didanosine and drugs in its class. People with peripheral neuropathy who were taking didanosine were found to be deficient in acetyl-L-carnitine.2 Some researchers have suggested that supplementing acetyl-L-carnitine may assist in managing this condition.3

Interactions with Herbs

Shiitake (Lentinas edodes)
Lentinan is a complex sugar found in shiitake mushrooms and is recognized as an immune modulator. In an early human trial, 88 HIV-infected people received didanosine (400 mg per day) plus a 2 mg lentinan injection per week.4 Didanosine-lentinan combination therapy improved CD4 immune cell counts for a significantly longer period than didanosine alone. Lentinan is under investigation as an adjunct therapy to be used with didanosine for HIV infection.5 Oral preparations of shiitake are available, but it is not known if they would be an effective treatment with didanosine for HIV infection.

Interactions with Foods and Other Compounds

Food
Didanosine should be taken on an empty stomach, one hour before or two hours after eating food.6

References

1. Fouty B, Frerman F, Reves R. Riboflavin to treat nucleoside analogue-induced lactic acidosis. Lancet 1998;352:291–2 [letter].

2. Famularo G, Moretti S, Marcellini S, et al. Acetyl-carnitine deficiency in AIDS patients with neurotoxicity on treatment with antiretroviral nucleoside analogues. AIDS 1997;11:185–90.

3. Moyle GJ, Sadler M. Peripheral neuropathy with nucleoside antiretrovirals: risk factors, incidence and management. Drug Saf 1998;19:481–94 [Review].

4. Gordon M, Guralnik M, Kaneko Y, et al. A phase II controlled study of a combination of the immune modulator, lentinan, with didanosine (ddI) in HIV patients with CD4 cells of 200–500/mm3. J Med 1995;26:193–207.

5. Threlkeld DS, ed. News, Keeping Up, December 1994, Lentinan. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Dec 1997, 805.

6. Threlkeld DS, ed. Anti-Infectives, Antiviral Agents, Didanosine. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1993, 406k–6t.