{"id":289,"date":"2009-03-01T19:47:34","date_gmt":"2009-03-02T00:47:34","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=289"},"modified":"2009-03-01T19:47:34","modified_gmt":"2009-03-02T00:47:34","slug":"sedation-for-colonoscopies-in-hiv-patients-debate-rages","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/sedation-for-colonoscopies-in-hiv-patients-debate-rages\/2009\/03\/01\/","title":{"rendered":"Sedation for Colonoscopies in HIV Patients: Debate Rages"},"content":{"rendered":"<p>Here&#8217;s a problem we&#8217;re grappling with:<\/p>\n<p>A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen.<\/p>\n<p>(This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.)<\/p>\n<p>For efavirenz, midazolam is contraindicated; for ritonavir, same story &#8212; or &#8220;consider therapy modification&#8221;, according to one source I found.\u00a0 Ditto fentanyl.<\/p>\n<p>So what should be given for sedation?\u00a0 (Important side note: if you told me pre-1996 that this would be a critical management question for my HIV patients, I would have thought you were out of your mind.)<\/p>\n<p>Lots of different views here in Boston, including:<\/p>\n<ul>\n<li>Give the usual meds, titrate to effect<\/li>\n<li><em>NEVER <\/em>give midazolam with either efavirenz or ritonavir; instead, use lorazepam, etc<\/li>\n<li>Stop HIV meds 1 day in advance, then give midazolam and fentanyl<\/li>\n<\/ul>\n<p>Does anyone know?\u00a0 Or does anyone have sufficient experience to share?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Here&#8217;s a problem we&#8217;re grappling with: A patient with HIV needs a colonoscopy, but is on either a ritonavir-boosted protease inhibitor or an efavirenz-based regimen. (This must be something like 90% of HIV patients as of March 1, 2009, based on my extremely unscientific gut impression.) For efavirenz, midazolam is contraindicated; for ritonavir, same story [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,4,8],"tags":[215,355,423,440,572,619,759,760,925],"class_list":["post-289","post","type-post","status-publish","format-standard","hentry","category-antiretroviral-rounds","category-hiv","category-patient-care","tag-colonoscopy","tag-fentanyl","tag-hiv","tag-hiv-patients","tag-lorazepam","tag-midazolam","tag-protease","tag-protease-inhibitor","tag-titrate"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/289","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=289"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/289\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=289"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=289"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=289"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}