| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) Phenytoin | Red: Avoid combination | Do not coadminister: Potential for reduced levels of rilpivirine | Decreased rilpivirine effects |
Use alternative agents |
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| Lenacapavir Phenytoin | Red: Avoid combination | Do not coadminister: reduced levels of lenacapavir | Potential loss of antiviral efficacy |
Contraindicated. Use alternative agents. |
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| Ritonavir Phenytoin 1090 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Increased phenytoin effects |
Not studied |
Increased phenytoin levels) |
Avoid combination and use alternative agents. Monitor phenytoin levels and adjust as indicated. Monitor virologic response. |
|
| Darunavir Phenytoin 962 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Potential loss of antiviral efficacy, Potential for decreased phenytoin effects |
Avoid combination and use alternative agents. If coadministering, monitor and adjust phenytoin levels as indicated and monitor viral load. |
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| Darunavir Phenytoin 955 | 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 Phenytoin 844 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Potential loss of antiretroviral efficacy |
Avoid combination or use alternative agents |
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| Atazanavir Phenytoin 834 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Contraindicated. Use alternative agents. |
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| Tenofovir alafenamide Phenytoin 721 | 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. |
|
| Etravirine Phenytoin 556 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of etravirine and phenytoin | Potential decreased etravirine effects; potential decreased anticonvulsants effects |
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| Efavirenz Phenytoin 486 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Decreased efavirenz and phenytoin effects |
Not studied (may decrease efavirenz levels) |
Not studied (may decrease phenytoin levels) |
Avoid combination and use alternative agents. If coadministering, \monitor phenytoin levels and adjust as indicated |
|
| Efavirenz Phenytoin 485 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Decreased efavirenz and phenytoin effects |
Not studied (may decrease efavirenz levels) |
Not studied (may decrease phenytoin levels) |
Avoid combination and use alternative agents. If coadministering, \monitor phenytoin levels and adjust as indicated |
|
| Doravirine Phenytoin 352 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of doravirine | Potential decrease in antiretroviral efficacy |
Contraindicated. Use alternative agents. If discontinuing phenytoin, a minimum 4 week cessation period is recommended prior to initiating doravirine. |
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| Cabotegravir Phenytoin 338 | 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. |
|
| Elvitegravir Phenytoin 217 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of elvitegravir | Potential decrease in antiretroviral efficacy |
Contraindicated. Use alternative agents. |
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| Dolutegravir Phenytoin 118 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Not studied (may decreased dolutegravir levels) |
Not studied |
Avoid combination or use alternative agents |
|
| Bictegravir Phenytoin 80 | 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 Phenytoin 40 | 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 Phenytoin 21 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of temsavir | Potential decrease in antiretroviral efficacy |
Contraindicated. Use alternative agents. |
