| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) Ketoconazole | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential for increased rilpivirine concentrations |
If coadministering, use standard doses and consider monitoring for antifungal efficacy and QTc prolongation |
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| Ritonavir Ketoconazole 1099 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Increased ritonavir effects |
Increased ritonavir levels) |
If coadministering consider keeping doses of ketoconazole < 200 mg daily |
||
| Darunavir Ketoconazole 999 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential for increased darunavir and ketoconazole adverse effects |
200 mg BID | Dose adjustment not established; if co-administration needed, ketoconazole dose should not exceed 200 mg daily |
||
| Atazanavir Ketoconazole 815 | Green: Administer standard doses | Administer standard doses | No significant change |
200 mg daily on days 7-13 | Not reported |
||
| Rilpivirine Ketoconazole 647 | Green: Administer standard doses | Administer standard doses | Decreased ketoconazole effects |
Rilvpivirine AUC increased 49%; Cmin increased 76%; Cmax increased 30% |
400 mg daily | Ketoconazole AUC decreased 24%; Cmin decreased 66%; Cmax decreased 15% |
Monitor for failure of antifungal therapy |
| Nevirapine Ketoconazole 618 | Red: Avoid combination | Do not coadminister: Reduced levels of ketoconazole | Decreased ketoconazole effects |
400 mg daily | Ketoconazole AUC decreased 72%; Cmax decreased 44% |
Use alternative agents |
|
| Efavirenz Ketoconazole 481 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Decreased ketoconazole effects |
Not studied (may decrease ketoconazole levels) |
Avoid combination and use alternative agents |
||
| Efavirenz Ketoconazole 480 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Decreased ketoconazole effects |
Not studied |
Not studied (may decrease ketoconazole levels) |
Avoid combination and use alternative agents |
|
| Efavirenz Ketoconazole 479 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Decreased ketoconazole effects |
Not studied |
Not studied (may decrease ketoconazole levels) |
Avoid combination and use alternative agents |
|
| Doravirine Ketoconazole 346 | Green: Administer standard doses | Administer standard doses | Potential for increased doravirine adverse effects |
AUC increased to 306%; Cmax increased by 25%; C24 increased to 275% |
400 mg daily | Not studied |
No dose adjustment necessary. Monitor for doravirine adverse effects. |
| Elvitegravir Ketoconazole 272 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential for increased adverse effects from both elvitegravir and ketoconazole |
If coadministering, ketoconazole dose should not exceed 200 mg daily. |
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| Maraviroc Ketoconazole 41 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Increased maraviroc effects |
Maraviroc AUC increased 400%; Cmax increased 238%; Cmin increased 275% |
400 mg daily | Not reported |
Reduce dose of maraviroc to 150 mg BID |
