| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Lenacapavir Voriconazole | Green: Administer standard doses | Administer standard doses | No clinically significant effect expected |
AUC increased 41%; Cmax increased 9% |
400 mg BID x 2 days then 200 mg BID | Not reported |
|
| Ritonavir Voriconazole 1087 | Red: Avoid combination | Do not coadminister: Reduced levels of voriconazole | Decreased voriconazole effects |
No significant change |
400 mg Q12H | Voriconazole AUC decreased 83%; Cmax decreased 68% |
Do not coadminister with ritonavir or other ritonavir-boosted protease inhibitors unless benefit outweighs risks. If coadministering consider therapeutic drug monitoring. |
| Ritonavir Voriconazole 1086 | Red: Avoid combination | Do not coadminister: Reduced levels of voriconazole | Decreased voriconazole effects |
No significant change |
400 mg Q12H | Voriconazole AUC decreased 39%; Cmax decreased 24% |
Do not coadminister with ritonavir or other ritonavir-boosted protease inhibitors unless benefit outweighs risks. If coadministering consider therapeutic drug monitoring. |
| Darunavir Voriconazole 960 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Potential decreased voriconazole effects |
Avoid coadministering with boosted protease inhibitors unless benefit outweighs risks. If coadministering, consider therapeutic drug monitoring. |
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| Atazanavir Voriconazole 863 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential decreased voriconazole antifungal effects |
200 mg PO Q12H | Voriconazole AUC decreased 39% when given with ritonavir 100 mg BID |
With unboosted atazanavir no dose adjustment necessary, monitor for toxicity. Do not coadminister with boosted protease inhibitors unless benefit outweighs risks. Consider therapeutic drug monitoring. |
|
| Etravirine Voriconazole 527 | Green: Administer standard doses | Administer standard doses | Potential for increased etravirine effects |
Etravirine AUC increased 36%; Cmin increased 52%; Cmax increased 26% |
200 mg BID | Voriconazole Cmin increased 23% |
|
| Efavirenz Voriconazole 387 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Efavirenz AUC increased 17%; Cmax no significant change |
400 mg Q12H on days 2-7 | Voriconazole Cmax increased 23% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
|
| Efavirenz Voriconazole 386 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Efavirenz AUC increased 17%; Cmax no significant change |
400 mg Q12H on days 2-7 | Voriconazole Cmax increased 23% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
|
| Efavirenz Voriconazole 385 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavirenz AUC increased 17%; Cmax no significant change |
400 mg Q12H on days 2-7 | Voriconazole Cmax increased 23%, AUC decreased 7% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 384 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavrenz AUC increased 44%; Cmax increased 38% |
400 mg PO Q12H on day 1, then 200 mg Q12H on days 2-8 | Voriconazole AUC decreased 77%; Cmax decreased 61% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 383 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavrenz AUC increased 44%; Cmax increased 38% |
400 mg PO Q12H on day 1, then 200 mg Q12H on days 2-8 | Voriconazole AUC decreased 77%; Cmax decreased 61% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 382 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavrenz AUC increased 44%; Cmax increased 38% |
400 mg PO Q12H on day 1, then 200 mg Q12H on days 2-8 | Voriconazole AUC decreased 77%; Cmax decreased 61% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 381 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Decreased voriconazole effects |
No significant change |
300 mg Q12H on days 2-7 | Voriconazole AUC decreased 55%; Cmax decreased 36% (compared to voriconazole 200 mg BID) |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 380 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Decreased voriconazole effects |
No significant change |
300 mg Q12H on days 2-7 | Voriconazole AUC decreased 55%; Cmax decreased 36% (compared to voriconazole 200 mg BID) |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 379 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Decreased voriconazole effects |
No significant change |
300 mg Q12H on days 2-7 | Voriconazole AUC decreased 55%; Cmax decreased 36% (compared to voriconazole 200 mg BID) |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Elvitegravir Voriconazole 239 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | If coadministering assess risk and benefit. Consider monitoring voriconaozle concentrations. |
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| Bictegravir Voriconazole 83 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potentially increased bictegravir adverse effects |
Cmax increased 9%, AUC increased 61% |
300 mg BID (fasted state) | Not reported |
Consider using alternative agents; if coadministering, monitor for bictegravir adverse effects |
| Maraviroc Voriconazole 54 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
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| Maraviroc Voriconazole 53 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
