DHHS Adult ARV Guidelines

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Department of Health and Human Services.

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DHHS Adult & Adolescent ARV Guidelines

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	Interaction Color Code	Clinical Bottom Line	Clinical Effects	Drug 1 effect	Drug 2 dose	Drug 2 effect	Management
Rilpivirine Esomeprazole 123	Red: Avoid combination	Do not coadminister: Reduced levels of rilpivirine	Decreased rilpivirine effects				Contraindicated. Use alternative agents.
Lenacapavir Pitavastatin 1	Green: Administer standard doses	Administer standard doses	No clinically significant effect expected	Not reported	2 mg x 1 (with food), administered 3 days after LEN	AUC decreased 4%
Lenacapavir Midazolam 1	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential for increased sedation	Not reported	2.5 mg orally x 1 with food, administered 1 day after LEN	AUC increased 308%; Cmax increased 116%. AUC for 1-hydroxy metabolite decreased 16%.	If co-administering, monitor for excess sedation and adjust dose accordingly
Lenacapavir Zolpidem	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of excessive sedation				If coadministering, initiate lowest starting dose. Monitor for excessive sedation.
Lenacapavir Warfarin	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of bleeding				Use with caution. Monitor INR and for warfarin adverse effects (e.g. bleeding)
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
Lenacapavir Vardenafil	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Increased risk of vardenafil adverse effects (e.g. flushing, headache, hypotension)				If co-administering vardenafil for erectile dysfunction, dose should not exceed 5 mg per 24 hour. Monitor for adverse effects.
Lenacapavir Triazolam	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Increased risk of triazolam adverse effects				If coadministering, monitor for triazolam adverse effects (e.g. sedation, respiratory depression).
Lenacapavir Trazodone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of trazodone adverse effects (e.g. sedation, CNS effects)				If coadministering start with lowest dose and titrate to clinical effect. Monitor for trazodone-related adverse events.
Lenacapavir Tramadol	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Increased risk of tramadol adverse effects				If coadministering, consider decreasing tramadol dose when coadministering. Titrate to clinical effect and monitor for sedation.
Lenacapavir Tenofovir alafenamide	Green: Administer standard doses	Administer standard doses	No clinically significant effect expected	Not reported	25 mg x 1	TAF AUC increased 32%; Cmax increased 24%. TFV AUC increased 47%; Cmax increased 23%
Lenacapavir Suvorexant	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of excessive sedation				If coadministering, initiate dose at 5 mg daily. May increase to 10 mg daily if not effective. Monitor for excessive sedation.
Lenacapavir St. John's Wort	Red: Avoid combination	Do not coadminister: reduced levels of lenacapavir	Potential loss of antiviral efficacy				Contraindicated. Use alternative agents.
Lenacapavir Simvastatin	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Increased risk of simvastatin adverse effects				Initiate simvastatin with the lowest starting dose and titrate to clinical effect. Monitor for adverse effects of lovastatin (e.g. myopathy, elevated transaminases).
Lenacapavir Rifapentine	Red: Avoid combination	Do not coadminister: reduced levels of lenacapavir	Potential loss of antiviral efficacy				Use alternative agents
Lenacapavir Quinidine	Red: Avoid combination	Do not coadminister: potentially increased levels of quinidine	Potential increased risk of quinidine adverse effects				Use alternative agents.
Lenacapavir Quetiapine	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of quetiapine adverse effects (e.g. sedation, QT prolongation)				Consider using alternative antipsychotics. If coadministering, consider quetiapine dose reduction and monitor for adverse effects.
Lenacapavir Propafenone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of propafenone adverse effects				Consider using alternative antiarrhythmic or ARV. If coadministering, monitor for propafenone adverse effects.
Lenacapavir Primidone	Red: Avoid combination	Do not coadminister: reduced levels of lenacapavir	Potential loss of antiviral efficacy				Use alternative agents.
Lenacapavir Prednisone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of corticosteroid adverse effects (e.g. Cushing's syndrome and adrenal supression).				If co-administering, initiate with the lowest starting dose and titrate to clinical effect. Monitor for corticosteroid-related adverse effects (e.g. Cushing's syndrome, adrenal insufficiency).
Lenacapavir Prednisolone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of corticosteroid adverse effects (e.g. Cushing's syndrome and adrenal supression).				If co-administering, initiate with the lowest starting dose and titrate to clinical effect. Monitor for corticosteroid-related adverse effects (e.g. Cushing's syndrome, adrenal insufficiency).
Lenacapavir Praziquantel	Yellow: Adjust dosing	Minimal data to guide interaction: risks likely to outweigh benefits	Potential increased risk of praziquantel adverse effects				Consider alternative antiretroviral. If coadministration is necessary, monitor for praziquantel adverse effects.
Lenacapavir Phenytoin	Red: Avoid combination	Do not coadminister: reduced levels of lenacapavir	Potential loss of antiviral efficacy				Contraindicated. Use alternative agents.
Lenacapavir Nevirapine	Red: Avoid combination	Do not coadminister: reduced levels of lenacapavir	Potential loss of antiviral efficacy				Use alternative agents
Lenacapavir Methylergonovine	Red: Avoid combination	Do not coadminister: potentially increased levels of methylergonovine	Increased risk of methylergonovine adverse effects				Use alternative agents
Lenacapavir Mavacamten	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of mavacamten adverse effects				If initiating lenacapavir in patients stable on mavacamten, reduce mavacamten dose by one level (e.g. 15 mg to 10 mg, 10 mg to 5 mg, 5 mg to 2.5 mg). If initiating mavacamten in patients stable on lenacapavir, use typical starting dose (5 mg daily).
Lenacapavir Lurasidone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of lurasidone adverse effects				If initiating lurasidone in a person stable on lenacapavir, recommended starting dose is 20 mg daily, not to exceed 80 mg daily. If initiating lenacapavir in a person stable on lurasidone, reduce lurasidone dose by 50%
Lenacapavir Lumateperone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of lumateperone adverse effects				If coadministering, reduce lumateperone dose to 21 mg
Lenacapavir Lovastatin	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Increased risk of lovastatin adverse effects				Initiate lovastatin with the lowest starting dose and titrate to clinical effect. Monitor for adverse effects of lovastatin (e.g. myopathy, elevated transaminases).
Lenacapavir Lidocaine	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of lidocaine adverse effects				Consider using alternative antiarrythmic or ARV. If coadministering, monitor for lidocaine adverse effects.
Lenacapavir Lamborexant	Red: Avoid combination	Do not coadminister: potentially increased levels of lamborexant	Potential increased risk of excessive sedation				Use alternative agents.
Lenacapavir Ivabradine	Red: Avoid combination	Do not coadminister: potentially increased levels of ivabradine	Potential increased risk of ivabradine adverse effects				Use alternative agents.
Lenacapavir Hydrocortisone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of corticosteroid adverse effects (e.g. Cushing's syndrome and adrenal supression).				If co-administering, initiate with the lowest starting dose and titrate to clinical effect. Monitor for hydrocortisone-related adverse effects.
Lenacapavir Flibanserin	Red: Avoid combination	Do not coadminster: potentially increased levels of flibanserin	Potential increased risk of GI adverse effects, insomnia, dry mouth, tachycardia				Use alternative agents.
Lenacapavir Fentanyl	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Increased risk of fentanyl adverse effects				If coadministering, monitor therapeutic effects and adverse reactions (e.g. sedation, respiratory depression)
Lenacapavir Famotidine	Green: Administer standard doses	Administer standard doses	No clinically significant effect expected	AUC increased 28%	40 mg daily	Not reported
Lenacapavir Etravirine	Red: Avoid combination	Do not coadminister: potentially reduced levels of lenacapavir	Potential loss of antiviral efficacy				Use alternative agents.
Lenacapavir Ethosuximide	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased ethosuximide effects				If coadministering monitor for ethosuximide-related adverse events.
Lenacapavir Eszopiclone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of excessive sedation				If coadministering, initiate lowest starting dose. Monitor for excessive sedation.
Lenacapavir Eslicarbazepine	Red: Avoid combination	Do not coadminister: reduced levels of lenacapavir	Potential loss of antiviral efficacy				Use alternative agents.
Lenacapavir Ergotamine	Red: Avoid combination	Do not coadminister: potentially increased levels of ergotamine	Increased risk of ergotamine adverse effects				Use alternative agents
Lenacapavir Efavirenz	Red: Avoid combination	Do not coadminister: decreased levels of lenacapavir	Potential for loss of lenacapavir efficacy	AUC decreased 55%; Cmax decreased 36%	600 mg daily (fasted)	Not reported	Use alternative agents
Lenacapavir Disopyramide	Red: Avoid combination	Do not coadminister: potentially increased levels of disopyramide	Potential increased risk of disopyramide adverse effects				Use alternative agents.
Lenacapavir Diltiazem	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of diltiazem adverse effects				If coadministering, monitor for cardiac medication adverse effects (e.g. hypotension)
Lenacapavir Dihydroergotamine	Red: Avoid combination	Do not coadminister: potentially increased levels of dihydroergotamine	Increased risk of dihydroergotamine adverse effects				Use alternative agents
Lenacapavir Dexamethasone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of corticosteroid adverse effects (e.g. Cushing's syndrome and adrenal supression).				If co-administering, initiate with the lowest starting dose and titrate to clinical effect. Do not use doses of dexamethasone > 16 mg. Monitor for dexamethasone-related adverse effects.
Lenacapavir Dabigatran	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of bleeding				Use with caution. Monitor for dabigatran adverse effects (e.g. bleeding)
Lenacapavir Colchicine	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of GI adverse effects				If using for gout flare may coadminister a single dose of 1.2 mg. May not repeat dose for at least 3 days. If using for Familiar Mediterranean Fever do not exceed colchicine dose of 1.2 mg daily.
Lenacapavir Cobicistat	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Increased risk of lenacapavir adverse effects	AUC increased 128%; Cmax increased 110%	150 mg once daily (in fed state)	Not reported	Management of interaction depends on component that cobicistat is serving as a PK booster for. See partner antiretroviral for further details.
Lenacapavir Clonazepam	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of sedation, respiratory depression				Consider alternative benzodiazepines. If coadministering, use lowest effective dose and monitor for clonazepam adverse effects.
Lenacapavir Cisapride	Red: Avoid combination	Do not coadminister: potentially increased levels of cisapride	Potential increased risk of cisapride adverse effects				Contraindicated. Use alternative agents
Lenacapavir Carbamazepine	Red: Avoid combination	Do not coadminister: reduced levels of lenacapavir	Potential loss of antiviral efficacy				Contraindicated. Use alternative agents.
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).
Lenacapavir Brexpiprazole	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of brexpiprazole adverse effects				If coadministering in patients known to be poor CYP2D6 metabolizers, use 1/4 of brexpiprazole dose. Monitor for adverse events.
Lenacapavir Betamethasone	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of corticosteroid adverse effects (e.g. Cushing's syndrome and adrenal supression).				If used for local injections, monitor for corticosteroid-related adverse effects (e.g. Cushing's syndrome, adrenal insufficiency).
Lenacapavir Bedaquiline	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential for increased bedaquiline levels				Consider alternative agents. If coadministering, monitor LFTs and ECG.
Lenacapavir Avanafil	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of avanafil adverse effects (e.g. hypotension)				If coadministering, avanafil dose should not exceed 50 mg in 24 hours
Lenacapavir Atazanavir/ritonavir	Red: Avoid combination	Do not coadminister: potentially increased levels of lenacapavir	Potential increase in lenacapavir adverse effects				Use alternative agents
Lenacapavir Apixaban	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of bleeding				Use with caution. Monitor for apixaban adverse effects (e.g. bleeding)
Lenacapavir Amlodipine	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of amlodipine adverse effects				If coadministering, monitor for cardiac medication adverse effects (e.g. hypotension)
Lenacapavir Amiodarone	Red: Avoid combination	Do not coadminister: potentially increased levels of amiodarone	Potential increased risk of amiodarone and lenacapavir adverse effects				Use alternative agents.
Lenacapavir Alprazolam	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential increased risk of sedation, respiratory depression				If coadministering, use lowest effective dose and monitor for alprazolam adverse effects
Lencapavir Alfuzosin	Yellow: Adjust dosing	Minimal data to guide interaction: weigh risks and benefits of using this combination	Potential for increased alfuzosin effects				Consider alternative to alfuzosin. If coadministered, monitor for adverse effects (e.g. hypotension)

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