| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Lenacapavir Buprenorphine | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Unknown effect on buprenorphine |
If initiating buprenorphine in a person already on lenacapavir, start with lowest feasible dose and titrate to clinical effect. If initiating lenacapavir in a person stable on buprenorphine, dose adjustment of buprenorphine may be required. Monitor for clinical efficacy and adverse effects (e.g. sedation, respiratory depression). |
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| Darunavir Buprenorphine / naloxone 866 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of buprenorphine / naloxone | Potential for increased buprenorphine / naloxone effects |
Not studied |
8-16 / 2-4 mg | Norbuprenorphine: Cmax increase 36%, AUC increase 46%, Cmin increase 71% |
If initiating buprenorphine / naloxone in patients taking DRV / r or DRV / c, carefully titrate dose to desired effect |
| Tenofovir disoproxil fumarate Buprenorphine / naloxone 738 | Green: Administer standard doses | Administer standard doses | No significant change |
14-16 mg once daily | No significant change |
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| Lamivudine Buprenorphine / naloxone 696 | Green: Administer standard doses | Administer standard doses | 14 mg daily | No significant change |
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| Efavirenz Buprenorphine / naloxone 404 | Green: Administer standard doses | Administer standard doses | Possible decreased buprenorphine effects |
No significant change |
stable dose for at least 2 weeks | Buprenorphine AUC decreased 49%; Cmax decreased 45%, Cmin decreased 50%; half-life: decreased 29% |
Monitor for signs and symptoms of opioid withdrawal; some patients may need an increase in the buprenorphine dose, though study patients did not go into opioid withdrawal |
| Raltegravir Buprenorphine / naloxone 307 | Green: Administer standard doses | Administer standard doses | No significant change |
stable dose for at least 3 weeks | No significant change |
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| Elvitegravir Buprenorphine / naloxone 129 | Green: Administer standard doses | Administer standard doses | Potential for increased risk of sedation and decreased cognition |
Not reported |
16-24 mg once daily | Buprenorphine Cmax increased 12%, AUC increased 35%, Cmin increased 66%. Norbuprenorphine metabolite Cmax increased 24%, AUC increased 42%, Cmin increased 57% |
If using, monitor closely for excess sedation and cognitive effects |
| Fostemsavir Buprenorphine / naloxone 12 | Green: Administer standard doses | Administer standard doses | Not studied |
8mg / 2mg to 24mg / 6mg once daily, individual dosing | Buprenorphine Cmax increased 24%, AUC increased 30%, Cmin increased 39%. Norbuprenorphine Cmax increased 24%, AUC increased 39%, Cmin increased 39% |
