| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Atazanavir SOF/VEL/VOX 819 | Red: Avoid combination | Do not coadminister: Increased levels of voxilaprevir | Contraindicated. Use alternative agents. |
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| Tenofovir disoproxil fumarate SOF/VEL/VOX 751 | 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) |
Increase AUC 30-80% when given with various ARV containing TDF |
Not studied |
If coadministering, monitor for TDF adverse effects |
|
| Tenofovir alafenamide SOF/VEL/VOX 714 | Green: Administer standard doses | Administer standard doses | Cmax decreased 21%; AUC decreased 7% |
400 / 100 / 100mg + 100mg voxilaprevir once daily | Sofosbuvir Cmax increased 14%, AUC increased 9%. Velpatasvir Cmax decreased 4%, AUC decreased 4%, Cmin decreased 6%. Voxilaprevir Cmax decreased 10%, AUC decreased 9%, Cmin decreased 3% |
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| Tenofovir alafenamide SOF/VEL/VOX 713 | Green: Administer standard doses | Administer standard doses | Cmax increased 28%, AUC increased 57% |
400 / 100 / 100 + 100 once daily | Sofosbuvir Cmax increased 14%, AUC increased 9%. Velpatasvir Cmax decreased 4%, AUC decreased 4%, Cmin decreased 6%. Voxilaprevir Cmax decreased 10%, AUC decreased 9%, Cmin decreased 3% |
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| Nevirapine SOF/VEL 629 | Red: Avoid combination | Do not coadminister: potientially reduced levels of velpatasvir and voxilaprevir | Potential loss of anti-HCV efficacy |
Not studied (may decrease velpatasvir and voxilaprevirlevels) |
Contraindicated. Use alternative agents. |
||
| Etravirine SOF/VEL 551 | Red: Avoid combination | Do not coadminister: potientially reduced levels of velpatasvir and voxilaprevir | Potential loss of anti-HCV efficacy |
Not studied |
Not studied (may decrease velpatasvir and voxilaprevirlevels) |
Contraindicated. Use alternative agents. |
|
| Efavirenz SOF/VEL 467 | Red: Avoid combination | Do not coadminister: Reduced levels of velpatasvir and voxilapervir | Reduced levels of velapatasvir and voxilaprevir |
Velpatasvir Cmax decreased 37%; AUC decreased 43%; Cmin decreased 47% |
Contraindicated. Use alternative agents. |
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| Efavirenz SOF/VEL 466 | Red: Avoid combination | Do not coadminister: Reduced levels of velpatasvir and voxilapervir | Reduced levels of velapatasvir and voxilaprevir |
Velpatasvir Cmax decreased 37%; AUC decreased 43%; Cmin decreased 47% |
Contraindicated. Use alternative agents. |
||
| Efavirenz SOF/VEL 465 | Red: Avoid combination | Do not coadminister: Reduced levels of velpatasvir and voxilapervir | Reduced levels of velapatasvir and voxilaprevir |
Velpatasvir Cmax decreased 37%; AUC decreased 43%; Cmin decreased 47% |
Contraindicated. Use alternative agents. |
||
| Elvitegravir SOF/VEL/VOX 140 | Green: Administer standard doses | Administer standard doses | Cmax decreased 21%; AUC decreased 6%; Cmin increased 32% |
400 / 100 / 100 mg plus 100 mg voxilaprevir | Voxilaprevir Cmax increased 92%; AUC increased 171%; Cmin increased 350%. Velpatasvir AUC increased 16%; Cmin increased 46%. Sofosbuvir Cmax increased 27%; AUC increased 22% |
If coadministering with Stribild, monitor for TDF related adverse effects. Consider monitoring for hepatotoxicity when coadministering with either Stribild or Genvoya |
|
| Bictegravir SOF/VEL/VOX 70 | Green: Administer standard doses | Administer standard doses | Cmax decreased 2%, AUC increased 7%, Cmin increased 10% |
400 / 100 / 100 + 100 voxilaprevir once daily (fed state) | Sofosbuvir Cmax increased 14%, AUC increased 9%. Velpatasvir Cmax decreased 4%, AUC decreased 4%, Cmin decreased 6%. Voxilaprevir Cmax decreased 10%, AUC decreased 9%, Cmin decreased 3% |
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| Fostemsavir SOF/VEL/VOX 26 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits benefit | Increased exposure of voxilaprevir and risk of ALT elevations |
Avoid combination; use alternative HCV regimen |
