| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) RFB | Red: Avoid combination | Do not coadminister: Potential for reduced levels of rilpivirine | Decreased rilpivirine effects |
Use alternative agents |
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| Lenacapavir Rifabutin | Red: Avoid combination | Do not coadminister: reduced levels of lenacapavir | Potential loss of antiviral efficacy |
Use alternative agents |
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| Ritonavir RFB 1043 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Increased rifabutin effects (eg, uveitis) |
150 mg daily x 24 days | Rifabutin AUC increased 400%; Cmax increased 250% |
Decrease rifabutin to 150 mg every other day or 300 mg 3 times / week |
|
| Darunavir RFB 886 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Increased darunavir and rifabutin effects. Note that lower rifabutin exposure has been reported in HIV- infected patients as compared to healthy study participants. |
Darunavir Cmax increase 42%, AUC increase 57%, Cmin increase 75%; Ritonavir Cmax increase 68%, AUC increase 66%, Cmin increase 31% |
150 mg every other day | Rifabutin: Cmax decrease 28%, AUC decrease 7%, Cmin increase 64%; 25-O-desacetylrifabutin: Cmax increase 377%, AUC increase 881%, Cmin increase 2610% |
Dose reduction of RFB by 75% of usual dose is recommended, such as rifabutin 150 mg every other day. Monitor for antimycobacterial activity and adverse events. Consider therapeutic drug monitoring. |
| Atazanavir RFB 768 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Atazanavir Cmax increased 34% |
150 mg daily on days 15-28 | Not reported |
Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring. |
|
| Atazanavir RFB 767 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Potential increase in atazanavir adverse effects |
Atazanavir AUC increased 191%, Cmax increased 81% |
150 mg daily on days 15-28 | Not reported |
Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring. |
| Atazanavir RFB 766 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Increased rifabutin effects (eg, uveitis) |
Not reported |
300 mg daily on days 1-10, then 150 mg daily on days 11-20 | Rifabutin AUC increased 110%, Cmax increased 118%, Cmin increased 243%, 25-O-desacetylrifabutin AUC increased 2101%, Cmax increased 720%, Cmin increased 7460% |
Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring. |
| Tenofovir alafenamide RFB 717 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of TAF | Potential decrease in antiretroviral efficacy |
Not studied |
Not studied |
Contraindicated. Use alternative agents. |
|
| Rilpivirine RFB 665 | Red: Avoid combination | Do not coadminister: Reduced levels of rilpivirine | Decreased rilpivirine effects |
Rilpivirine AUC decreased 46%; Cmin decreased 49%; Cmax decreased 35% |
300 mg daily | Use alternative agents |
|
| Nevirapine RFB 596 | Green: Administer standard doses | Administer standard doses | Decreased antiviral efficacy |
AUC decreased 31% |
AUC increased 26% |
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| Nevirapine RFB 595 | Green: Administer standard doses | Administer standard doses | Decreased antiviral efficacy |
No significant change in nevirapine Cmin |
150 or 300 mg daily | AUC increased 17%, Cmax increased 28% and 25-O-desacetyl-rifabutin AUC increased 24% |
|
| Etravirine RFB 520 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
Etravirine AUC decreased 37%; Cmax decreased 37%; Cmin decreased 35% |
300 mg daily | Rifabutin AUC decreased 17%; Cmin decreased 24%; 25-O-desacetylrifabutin AUC decreased 17%; Cmax decreased 15%; Cmin decreased 22% |
Administer rifabutin 300 mg once daily with etravirine. If etravirine and a protease inhibitor are used together, do not coadminister with rifabutin. |
| Efavirenz RFB 376 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Not studied |
600 mg twice weekly | Rifabutin AUC no significant change; Cmax no significant change (when compared to rifabutin 300 mg twice weekly without efavirenz) |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
|
| Efavirenz RFB 375 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Potential decreased rifabutin effects |
Not studied |
300 mg or 450 mg twice weekly | On 300 mg rifabutin twice weekly, rifabutin level 2 hours after dose: no significant change; rifabutin level 6 hours post dose: decreased 27%; on 450 mg twice weekly, rifabutin level 2 hours post dose: no significant change; rifabutin level 6 hours post dose: decreased 58%(all values compared to rifabutin alone) |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Efavirenz RFB 374 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
No significant change |
300 mg daily x 14 days | Rifabutin AUC decreased 38%; Cmax decreased 32%; Cmin decreased 45% |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Efavirenz RFB 373 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
No significant change |
300 mg daily x 14 days | Rifabutin AUC decreased 38%; Cmax decreased 32%; Cmin decreased 45% |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Efavirenz RFB 372 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
No significant change |
300 mg daily x 14 days | Rifabutin AUC decreased 38%; Cmax decreased 32% |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Doravirine RFB 356 | Red: Avoid combination | Do not coadminister: Reduced levels of doravirine | Potential decrease in antiretroviral efficacy |
AUC decreased 50%; Cmin decreased 68% |
300 mg daily | Not studied |
Contraindicated. Use alternative agents. If discontinuing the rifamycin, at least a 4 week cessation period is recommended prior to beginning doravirine. |
| Cabotegravir RFB 327 | Green: Administer standard doses | Administer standard doses | Cmax decreased 17%, AUC decreased 23%, Cmin decreased 26% |
300 mg once daily | Not studied |
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| Raltegravir RFB 285 | Yellow: Adjust dosing | Administer standard doses | Raltegravir AUC increased 19%; Cmax increased 39%; Cmin decreased 20% |
300 mg daily x 14 d | |||
| Elvitegravir RFB 135 | Red: Avoid combination | Do not coadminister: Increased levels of rifabutin, reduced levels of elvitegravir | Increased rifabutin effects, potential loss of antiretroviral activity |
Cmax decreased 9%, AUC decreased 21%, Cmin decreased 67% |
150 mg every other day | No significant change in rifabutin Cmin, AUC, or Cmax. 25-O-desacetylrifabutin metabolite Cmax increased 384%, AUC increased 625%, Cmin increased 394% as compared to 300 mg rifabutin alone. |
Use alternative agents |
| Dolutegravir RFB 97 | Green: Administer standard doses | Administer standard doses | Cmax increased 16%, AUC decreased 5%, Cmin decreased 30% |
300 mg once daily | Not studied |
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| Bictegravir RFB 82 | Red: Avoid combination | Do not coadminister: Reduced levels of bictegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 20%, AUC decreased 38%, Cmin decreased 56% |
300 mg once daily (fasted) | Not reported |
Use alternative agents |
| Maraviroc RFB 55 | Green: Administer standard doses | Administer standard doses | Maraviroc AUC no change; Cmin decreased 30% |
300 mg daily | Not reported |
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| Fostemsavir RFB 2 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Temsavir Cmax decreased 27%, AUC decreased 30%, Cmin decreased 41% |
300 mg once daily | Not reported |
Use standard dose rifabutin if coadministering with fostemsavir. If using fostemsavir in combination with a ritonavir boosted protease inhibitor, lower rifabutin dose to 150 mg daily. |
