| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) CBZ | Red: Avoid combination | Do not coadminister: Potential for reduced levels of rilpivirine | Decreased rilpivirine effects |
Use alternative agents |
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| Lenacapavir Carbamazepine | Red: Avoid combination | Do not coadminister: reduced levels of lenacapavir | Potential loss of antiviral efficacy |
Contraindicated. Use alternative agents. |
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| Ritonavir CBZ 1088 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Increased carbamazepine effects; decreased ritonavir effects |
Decreased ritonavir levels) |
350 mg BID | Not studied (may increase carbamazepine levels) |
Avoid combination and use alternative agents. If coadministering monitor carbamazepine levels and adjust as indicated. Monitor antiviral efficacy |
| Darunavir CBZ 1029 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Increased carbamazepine effects |
Darunavir: No significant change; Ritonavir cmax decreased 44%, AUC decreased 49%, Cmin decreased 56% |
200 mg BID | Cmax increase 43%, AUC increase 45%, Cmin increase 54% |
Monitor anticonvulsant level and adjust accordingly. Consider carbamazepine dose reduction by 25-50%. Monitor antiviral efficacy |
| Darunavir CBZ 952 | 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 CBZ 835 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of atazanavir | Potential loss of antiviral efficacy |
Contraindicated. Use alternative agents. |
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| Tenofovir alafenamide CBZ 725 | Red: Avoid combination | Do not coadminister: Reduced levels of TAF | Potential decrease in antiretroviral efficacy |
Cmax decreased 57%, AUC decreased 55% |
300 mg BID | Not reported |
Contraindicated. Use alternative agents. |
| Rilpivirine CBZ 658 | Red: Avoid combination | Contraindicated | |||||
| Nevirapine CBZ 636 | Orange: Minimal data to guide interaction | minimal data to guide interaction: weigh risks and benefits of using this combination | Potential decreased anticonvulsant and NVP concentration |
If coadministring, monitor anticonvulsant and NVP concentration |
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| Etravirine CBZ 555 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of etravirine and carbamazepine | Potential decreased etravirine effects; potential decreased anticonvulsants effects |
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| Efavirenz CBZ 512 | Orange: Minimal data to guide interaction | Decreased efavirenz and carbamazepine effects |
Not studied (may decrease efavirenz levels) |
Not studied (may decrease carbamazepine levels) |
Use alternative agents. If coadministering, monitor carbamazepine levels and adjust as indicated. Monitor antiviral efficacy |
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| Efavirenz CBZ 506 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Decreased efavirenz and carbamazepine effects |
EFV auc decreased 36%, Cmax decreased 21%, Cmin decreased 47% |
200 mg daily x 3 days, 200 mg BID x 3 days, 400 mg daily for 15 days | Use alternative agents. If coadministering, monitor carbamazepine levels and adjust as indicated. Monitor antiviral efficacy |
|
| Efavirenz CBZ 505 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Decreased efavirenz and carbamazepine effects |
Not studied (may decrease efavirenz levels) |
200 mg daily x 3 days, 200 mg BID x 3 days, 400 mg daily for 20 days. | Carbmazepine AUC decreased 27%, Cmin decreased 35%, Cmax decreased 20% |
Use alternative agents. If coadministering, monitor carbamazepine levels and adjust as indicated. Monitor antiviral efficacy |
| Efavirenz CBZ 504 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Decreased efavirenz and carbamazepine effects |
Not studied (may decrease efavirenz levels) |
200 mg daily x 3 days, 200 mg BID x 3 days, 400 mg daily for 20 days. | Carbmazepine AUC decreased 27%, Cmin 35%, Cmax decreased 20% |
Use alternative agents. If coadministering, monitor carbamazepine levels and adjust as indicated. Monitor antiviral efficacy |
| Efavirenz CBZ 443 | Red: Avoid combination | Do not coadminister: Reduced levels of carbamazepine and efavirenz | Decreased efavirenz and carbamazepine levels |
Efavirenz AUC decreased 36%; Cmax decreased 21%; Cmin decreased 47% |
200 mg daily on days 1-3, 200 mg BID on days 4-6, 400 mg daily thereafter | Carbamazepine AUC decreased 27%; Cmax decreased 20%; Cmin decreased 35% |
Avoid combination and use alternative agents. If coadministering monitor carbamazepine levels and adjust as indicated. Monitor antiviral efficacy |
| Doravirine Carbamazepine 347 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of doravirine | Potential decrease in antiretroviral efficacy |
Contraindicated. Use alternative agents. If discontinuing carbamazepine, a minimum 4 week cessation period is recommended prior to initiating doravirine. |
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| Cabotegravir CBZ 333 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of CAB | Potential decrease in antiretroviral efficacy |
Not studied |
Not studied |
Contraindicated. Use alternative agents. |
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| Raltegravir CBZ 317 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of raltegravir | Potential decrease in antiretroviral efficacy |
Use alternative agents |
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| Elvitegravir CBZ 136 | Red: Avoid combination | Do not coadminister: Reduced levels of elvitegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 45%, AUC decreased 69%, Cmin decreased 97% |
200 mg BID | Cmax increased 40%, AUC increased 43%, Cmin increased 51%. Epoxide metabolite (pharmacologically active) Cmax decreased 73%, AUC decreased 35%, and Cmin decreased 41%. |
Contraindicated. Use alternative agents. |
| Dolutegravir CBZ 124 | Red: Avoid combination | Do not coadminister: Reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 33%, AUC decreased 49%, Cmin decreased 73% |
300 mg BID | Not studied |
Use alternative agents. If this combination must be used in an INSTI-na•ve adult patient, adminster dolutegravir 50 mg twice daily. Do not use in cases of clinically suspected InSTI resistance. Monitor antiviral efficacy |
| Bictegravir CBZ 77 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of BIC and TAF | Potential decrease in antiretroviral efficacy |
Use alternative agents |
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| Maraviroc CBZ 37 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of maraviroc | Potential decrease in antiretroviral efficacy |
Increase maraviroc dose to 600 mg BID. If including MVC, ETR plus a strong CYP3A4 inhibitor in the regimen, reduce maraviroc dose to 150 mg BID |
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| Fostemsavir CBZ 17 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of temsavir | Potential decrease in antiretroviral efficacy |
Contraindicated. Use alternative agents. |
