| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) RIF | Red: Avoid combination | Do not coadminister: Potential for reduced levels of rilpivirine | Decreased rilpivirine effects |
Use alternative agents |
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| Lenacapavir Rifampin | Red: Avoid combination | Do not coadminister: decreased levels of lenacapavir | Potential decrease in antiretroviral efficacy |
AUC decreased 84%; Cmax decreased 55% |
600 mg daily (fasted) | Not reported |
Use alternative agents |
| Ritonavir RIF 1085 | Red: Avoid combination | Do not coadminister: Reduced levels of ritonavir | Decreased ritonavir effects |
Ritonavir AUC decreased 35%; Cmax decreased 25% |
300 mg or 600 mg x 10 days | Use alternative agents |
|
| Darunavir RIF 951 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of darunavir | Potential loss of antiviral efficacy |
Contraindicated. Use alternative agents. |
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| Atazanavir RIF 839 | Red: Avoid combination | Do not coadminister: Reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC no significant change, Cmax decreased 18%, Cmin decreased 40%(compared to atazanavir 400 mg daily) |
600 mg daily x 10 d | Not reported |
Contraindicated. Use alternative agents. |
| Atazanavir RIF 838 | Red: Avoid combination | Do not coadminister: Reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 72%, Cmax decreased 53%, Cmin decreased 98% |
600 mg daily x 10 d | Not reported |
Contraindicated. Use alternative agents. |
| Atazanavir RIF 837 | Red: Avoid combination | Do not coadminister: Reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 57%, Cmax decreased 56%, Cmin decreased 93%(compared to atazanavir 400 mg daily) |
600 mg daily x 10 d | Not reported |
Contraindicated. Use alternative agents. |
| Atazanavir RIF 836 | Red: Avoid combination | Do not coadminister: Reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 31%, Cmax decreased 40%, Cmin decreased 80%(compared to atazanavir 400 mg daily) |
600 mg daily x 10 d | Not reported |
Contraindicated. Use alternative agents. |
| Tenofovir disoproxil fumarate RIF 745 | Green: Administer standard doses | Administer standard doses | No significant change |
600 mg once daily | No significant change |
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| Tenofovir alafenamide RIF 718 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of TAF | Potential decrease in antiretroviral efficacy |
Dosed once: AUC decreased 55%; dosed twice: AUC decreased 14% |
Not studied |
Contraindicated. Use alternative agents. |
|
| Rilpivirine RIF 664 | Red: Avoid combination | Do not coadminister: Reduced levels of rilpivirine | Decreased rilpivirine effects |
Rilpivirine AUC decreased 80%; Cmin decreased 89%; Cmax decreased 69% |
600 mg daily | No significant change |
Use alternative agents |
| Nevirapine RIF 625 | Red: Avoid combination | Do not coadminister: Reduced levels of nevirapine | Decreased nevirapine effects |
600 mg daily | Use alternative agents |
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| Nevirapine RIF 624 | Red: Avoid combination | Do not coadminister: Reduced levels of nevirapine | Decreased nevirapine effects |
450 mg if < 55 kg and 600 mg if > 55 kg x 7 days | Use alternative agents |
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| Nevirapine RIF 623 | Red: Avoid combination | Do not coadminister: Reduced levels of nevirapine | Decreased nevirapine effects |
Not studied |
Use alternative agents |
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| Nevirapine RIF 622 | Red: Avoid combination | Do not coadminister: Reduced levels of nevirapine | Decreased nevirapine effects |
600 mg daily | No significant change |
Use alternative agents |
|
| Etravirine RIF 545 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of etravirine | Significant decrease in etravirine efficacy |
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| Efavirenz RIF 395 | Green: Administer standard doses | Administer standard doses | Decreased efavirenz effects |
Efavirenz AUC decreased 26%; Cmax decreased 20%, Cmin decreased 32% |
600 mg x 7 days | Monitor for antiviral efficacy. May consider increasing efavirenz to 800 mg daily when used with rifampin |
|
| Efavirenz RIF 394 | Green: Administer standard doses | Administer standard doses | Decreased efavirenz effects |
Monitor for antiviral efficacy. May consider increasing efavirenz to 800 mg daily when used with rifampin |
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| Efavirenz RIF 393 | Green: Administer standard doses | Administer standard doses | Decreased efavirenz effects |
Efavirenz AUC decreased 26%; Cmax decreased 20% |
600 mg x 7 days | Monitor for antiviral efficacy. May consider increasing efavirenz to 800 mg daily when used with rifampin |
|
| Efavirenz RIF 392 | Green: Administer standard doses | Administer standard doses | Decreased efavirenz effects |
Efavirenz AUC decreased 22%; Cmax decreased 24%; Cmin decreased 25% |
600 mg daily x 14 days | No significant change |
Monitor for antiviral efficacy. May consider increasing efavirenz to 800 mg daily for patient's weighing 50 kg or more when used with rifampin |
| Doravirine RIF 357 | Red: Avoid combination | Do not coadminister: Reduced levels of doravirine | Potential decrease in antiretroviral efficacy. |
AUC decreased 88%; Cmax decreased 57%, Cmin decreased 97% |
600 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 RIF 343 | Red: Avoid combination | Do not coadminister: Reduced levels of CAB | Potential decrease in antiretroviral efficacy |
Cmax decreased 6%, AUC decreased 59%, Cmin decreased 50% |
600 mg once daily | Not studied |
Contraindicated. Use alternative agents. |
| Raltegravir RIF 283 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of raltegravir | Raltegravir AUC increased 27%; Cmin decreased 53%; Cmax increased 62% (compared to 400 mg raltegravir Q12H when given alone) |
600 mg daily | Dose raltegravir 800 mg orally twice daily. Do not coadminister raltegravir 1200 mg once daily with rifampin. |
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| Raltegravir RIF 282 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of raltegravir | Potential decrease in antiretroviral efficacy |
Raltegravir AUC increased 27%; Cmax increased 62%; Cmin decreased 53% (all compared to raltegravir 400 mg BID) |
600 mg daily | Not reported |
Dose raltegravir 800 mg orally twice daily. Do not coadminister raltegravir 1200 mg once daily with rifampin. |
| Raltegravir RIF 281 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of raltegravir | Potential decrease in antiretroviral efficacy |
Raltegravir AUC decreased 40%; Cmax decreased 38%; Cmin decreased 61% |
600 mg daily | Not reported |
Dose raltegravir 800 mg orally twice daily. Do not coadminister raltegravir 1200 mg once daily with rifampin. |
| Elvitegravir RIF 215 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of elvitegravir | Expected significant decreased in elvitegravir, cobicistat. Potential decreased antiretroviral efficacy |
Contraindicated. Use alternative agents. |
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| Dolutegravir RIF 88 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax increased 18%, AUC increased 33%, Cmin increased 22% (when compared to dolutegravir 50 mg once daily) |
600 mg daily | Not studied |
Adjust dose of dolutegravir to 50 mg twice daily for treatment-na•ve and treatment experienced, INSTI na•ve adult patients, in pediatrics, increased the weight-based dose to twice daily, Use alternate combinations in INSTI experienced or INSTI resistance patients |
| Dolutegravir RIF 87 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 43%, AUC decreased 54%, Cmin decreased 72% (when compared to dolutegravir 50 mg BID without rifampin) |
600 mg daily | Not studied |
Adjust dose of dolutegravir to 50 mg twice daily for treatment-na•ve and treatment experienced, INSTI na•ve adult patients, in pediatrics, increased the weight-based dose to twice daily, Use alternate combinations in INSTI experienced or INSTI resistance patients |
| Bictegravir RIF 81 | Red: Avoid combination | Do not coadminister: Reduced levels of bictegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 28%, AUC decreased 75% |
600 mg once daily (fed state) | Not reported |
Contraindicated. Use alternative agents. |
| Maraviroc RIF 34 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of maraviroc | Maraviroc AUC increased 4%; Cmax decreased 3% when compared to maraviroc 100 mg BID given alone. |
600 mg daily | Not reported |
Increase maraviroc dose to 600 mg BID. If also including a strong CYP3A4 inhibitor in the regimen, consider using an alternative agent due to difficulty predicting maraviroc concentrations. |
|
| Maraviroc RIF 33 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of maraviroc | Potential decrease in antiretroviral efficacy |
Maraviroc AUC decreased 63%; Cmax decreased 66%; Cmin decreased 78% |
600 mg daily | Not reported |
Increase maraviroc dose to 600 mg BID. If also including a strong CYP3A4 inhibitor in the regimen, consider using an alternative agent due to difficulty predicting maraviroc concentrations. |
| Fostemsavir RIF 24 | Red: Avoid combination | Do not coadminister: Reduced levels of temsavir | Potential decrease in antiretroviral efficacy |
Temsavir Cmax decreased 76%, AUC decreased 82% |
600 mg once daily | Not reported |
Contraindicated. Use alternative agents. |
