Were Additional Treatments Affecting the Pharmacokinetics Administered after Raltegravir Overdosing?

To the Editor We read the article entitled, “An HIV-infected Patient with No Serious Adverse Events after Overdosing on Raltegravir,” by Hosoda et al. published in Internal Medicine 2019 on September 18, 2019 (1). We would be grateful if the authors could provide us with some important evidence related to actual cases of overdose of Raltegravir, one of the key drugs for HIV treatment.

We would also like to address a question to the authors. The pharmacokinetics of Raltegravir were confirmed as being rapidly diminished to one-one hundredth within 18 hours in the patient's clinical course, which was assumed based on reference 8 in the manuscript. However, the authors only partially explained the pharmacokinetics, such as the metabolism and excretion after absorption. Did the medical team administer laxatives and activated charcoal, both of which are commonly used in emergency rooms (2), after delivering 24,000 mg of Raltegravir? If this information is added, then the authors' conclusion would be more persuasive.

Overdosing should be avoided even if patients with HIV have a higher prevalence of mental disorders, including major depressive disorder (3); however, a possibly safer regimen was indeed suggested by this patient's clinical course.

The authors state that they have no Conflict of Interest (COI).