| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) SOF/VEL | Green: Administer standard doses | Administer standard doses | |||||
| Darunavir SOF/VEL 916 | Green: Administer standard doses | Administer standard doses | Cmax decrease 10%, AUC decrease 8%, Cmin decrease 13%. |
400 / 100 mg | Sofosbuvir Cmax decrease 38%, AUC decrease 28%; Velpatasvir Cmax decrease 24%, AUC decrease 16%. |
||
| Atazanavir SOF/VEL 812 | Green: Administer standard doses | Administer standard doses | Atazanavir Cmax increased 9%, AUC increased 20%, Cmin increased 39%. |
400 mg / 100 mg | Sofosbuvir AUC increased 22%. Velpatasvir Cmax increased 55%, AUC increased 142%, Cmin increased 301% |
||
| Tenofovir disoproxil fumarate SOF/VEL 750 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potentially increased risk of TDF adverse effects (e.g. renal function decline) |
Cmax increased 36%; AUC increased 35%; Cmin increased 45% |
400 / 100mg once daily | Not studied |
If coadministering, monitor for TDF adverse effects |
| Tenofovir alafenamide SOF/VEL 715 | Green: Administer standard doses | Administer standard doses | Cmax decreased 20%, AUC decreased 13% |
400 / 100mg once daily | Sofosbuvir: Cmax increased 23%, AUC increased 37%; Sofosbuvir metabolite: Cmax increased 29%, AUC increased 48%, Cmin increased 58%; velpatasvir: Cmax increased 30%, AUC increased 50%, Cmin increased 60% |
||
| Rilpivirine SOF/VEL 657 | Green: Administer standard doses | Administer standard doses | Rilpivirine Cmin decreased 7% |
400 mg / 100 mg | |||
| Nevirapine SOF/VEL 628 | Red: Avoid combination | Do not coadminister: potientially reduced levels of velpatasvir | Potential loss of anti-HCV efficacy |
Not studied (may decrease velpatasvir levels) |
Contraindicated. Use alternative agents. |
||
| Nevirapine SOF/VEL 609 | Red: Avoid combination | Do not coadminister: Potential for reduced levels of sofosbuvir | Potential loss of anti-HCV efficacy |
Nevirapine AUC decreased 79%; Cmax decreased 20%; Cmin decreased 60%; half-life: decreased 66% |
Potential decrease in sofosbuvir and velpatasvir levels). |
Use alternative agents |
|
| Etravirine SOF/VEL 550 | Red: Avoid combination | Do not coadminister: potientially reduced levels of velpatasvir | Potential loss of anti-HCV efficacy |
Not studied |
Not studied (may decrease velpatasvir and sofosbuvir levels) |
Contraindicated. Use alternative agents. |
|
| Efavirenz SOF/VEL 464 | Red: Avoid combination | Do not coadminister: Reduced levels of velpatasvir and voxilapervir | Reduced levels of velapatasvir |
400 / 100 mg daily x 14 days | Velpatasvir AUC decreased 53%, Cmin 57%, Cmax decreased 47%. Sofobuvir Cmax increased 38%. |
Contraindicated. Use alternative agents. |
|
| Efavirenz SOF/VEL 463 | Red: Avoid combination | Do not coadminister: Reduced levels of velpatasvir and voxilapervir | Reduced levels of velapatasvir |
400 / 100 mg daily x 14 days | Velpatasvir AUC decreased 53%, Cmin 57%, Cmax decreased 47%. Sofobuvir Cmax increased 38%. |
Contraindicated. Use alternative agents. |
|
| Efavirenz SOF/VEL 462 | Red: Avoid combination | Do not coadminister: Reduced levels of velpatasvir | Efavirenz Cmin decreased 19%; AUC decreased 15%; Cmax deceased 10% |
400 mg / 100 mg for 14 days | Sofosbuvir Cmax increased 38%. Velpatasvir Cmax decreased 47%; AUC decreased 53%; Cmin decreased 57% |
Contraindicated. Use alternative agents. |
|
| Raltegravir SOF/VEL 312 | Green: Administer standard doses | Administer standard doses | Raltegravir Cmin increased 8%; AUC increased 5%. |
400 mg / 100 mg | Not reported |
||
| Elvitegravir SOF/VEL 141 | Green: Administer standard doses | Administer standard doses | Stribild is coformulated with tenofovir disoproxil fumarate and TDF levels are increased by sofosbuvir / velpatasvir. |
Cmax decreased 13%; AUC decreased 6%; Cmin increased 8% |
400 / 100 mg once daily | Velpatasvir Cmax increased 30%, AUC increased 50%, Cmin increased 60%; Sofosbuvir Cmax increased 23%, AUC increased 37%; Sofosbuvir metabolite Cmax increased 29%, AUC increased 48%, Cmin increased 58% |
Monitor TDF-related adverse reactions |
| Elvitegravir SOF/VEL 139 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Stribild is coformulated with tenofovir disoproxil fumarate and TDF levels are increased by sofosbuvir / velpatasvir. |
Cmax and AUC decreased 7%; Cmin decreased 3% |
400 / 100 mg once daily | Velpatasvir Cmax increased 5%, AUC increased 19%, Cmin increased 37%; Sofosbuvir Cmax increased 1%, AUC increased 24%; Sofosbuvir metabolite Cmax increased 13%, AUC increased 35%, Cmin increased 45% |
May coadminister with caution. Monitor for adverse reactions associated with TDF |
| Dolutegravir SOF/VEL 112 | Green: Administer standard doses | Administer standard doses | Not studied |
400 / 100 mg daily | Sofosbuvir Cmax decreased 12%, AUC decreased 8%. No significant change in sofosbuvir metabolite GS-331007. Velpatasvir Cmax decreased 6%, AUC decreased 9%, Cmin decreased 12%. |
