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Sunlenca Product Label
| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Lenacapavir Verapamil | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of verapamil adverse effects |
If coadministering, monitor for cardiac medication adverse effects (e.g. hypotension) |
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| Lenacapavir Ubrogepant | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of ubrogepant adverse effects |
If coadministering, avoid taking a second dose of ubrogepant within 24 hours |
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| Lenacapavir Triamcinolone | 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). |
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| Lenacapavir Thioridazine | Yellow: Adjust dosing | Minimal data to guide interaction: risks likely to outweigh benefits | Potential loss of antiviral efficacy |
Consider using alternative antipsychotic |
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| Lenacapavir Tadalafil | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Increased risk of tadalafil adverse effects (e.g. flushing, headache, hypotension) |
Pulmonary arterial hypertension: coadministration of lenacapavir with tadalafil is not recommended. Erectile dysfunction: When used on an "as needed" basis, tadalafil dose should not exceed 10 mg every 72 hours. If used once daily (chronic administration), tadalafil dose should not exceed 2.5 mg daily. |
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| Lenacapavir Tacrolimus | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of immunosuppressant adverse effects |
Initiate adjusted dose of immunosuppressant to account for increased concentration and follow up with therapeutic drug monitoring to refine dosing. Monitor for adverse effects of immunosuppressant. Consult with specialist as necessary. |
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| Lenacapavir Sirolimus | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of immunosuppressant adverse effects |
Initiate adjusted dose of immunosuppressant to account for increased concentration and follow up with therapeutic drug monitoring to refine dosing. Monitor for adverse effects of immunosuppressant. Consult with specialist as necessary. |
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| Lenacapavir Sildenafil | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Increased risk of sildenafil adverse effects (e.g. flushing, headache, hypotension). |
Use of PDE-5 inhibitors for pulmonary arterial hypertension (PAH): Concomitant administration of SUNLENCA with tadalafil for the treatment of PAH is not recommended. Use of PDE-5 inhibitors for erectile dysfunction (ED): Refer to the prescribing information of sildenafil for dose recommendations. Use of PDE-5 inhibitors for pulmonary arterial hypertension (PAH): Do not coadminaster sildenafil with Lenacapavir. Use of PDE-5 inhibitors for erectile dysfunction (ED): Adjust dosing to avoid increased levels sildenafil |
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| Lenacapavir Rosuvastatin | Green: Administer standard doses | Administer standard doses | Potential for increased rosuvastatin adverse effects (e.g. myalgias, increased transaminases) |
Not reported |
5 mg orally x 1 | AUC increased 31%; Cmax increased 57% |
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| Lenacapavir Rivaroxaban | 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 rivaroxaban adverse effects (e.g. bleeding). Avoid coadministration in persons with renal impairment (CrCL 15 - 80 ml/min) due to increased risk of bleeding. |
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| Lenacapavir Rimegepant | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of rimegepant adverse effects |
If coadministering, avoid taking a second dose of rimegepant within 48 hours |
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| Lenacapavir Rifabutin | Red: Avoid combination | Do not coadminister: reduced levels of lenacapavir | Potential loss of antiviral efficacy |
Use alternative agents |
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| Lenacapavir Ranolazine | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of ranolazine adverse effects |
If coadministering, do not exceed ranolazine dose of 500 mg twice daily. |
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| Lenacapavir Pitavastatin | Green: Administer standard doses | Administer standard doses | No clinically significant effect expected |
Not reported |
2 mg x 1 (with food, simultaneous administration with oral LEN) | AUC increased 11% |
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| Lenacapavir Pimozide | Red: Avoid combination | Do not coadminister: potentially increased levels of pimozide | Potential increased risk of pimozide adverse effects |
Contraindicated. Use alternative agents |
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| Lenacapavir Phenobarbital | Red: Avoid combination | Do not coadminister: reduced levels of lenacapavir | Potential loss of antiviral efficacy |
Use alternative agents |
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| Lenacapavir Oxycodone | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Increased risk of oxycodone adverse effects |
If coadministering, monitor therapeutic effects and adverse reactions (e.g. sedation, respiratory depression) |
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| Lenacapavir Oxcarbazepine | Red: Avoid combination | Do not coadminister: reduced levels of lenacapavir | Potential loss of antiviral efficacy |
Use alternative agents |
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| Lenacapavir Nifedipine | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of nifedipine adverse effects |
If coadministering, monitor for cardiac medication adverse effects (e.g. hypotension) |
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| Lenacapavir Naloxegol | Yellow: Adjust dosing | Minimal data to guide interaction: risks likely to outweigh benefits | Increased risk of naloxegol adverse effects |
Consider using alternative agents. If coadministration is unavoidable, decrease dose of naloxegol and monitor for adverse reactions. |
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| Lenacapavir Mometasone | 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 coadministering, initiate lowest starting dose and titrate to clinical effect. Monitor for adverse effects such as adrenal insufficiency and Cushing's syndrome. |
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| Lenacapavir Midazolam | 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, administered simultaneously with LEN | AUC increased 259%; Cmax increased 94%. AUC for 1-hydroxy metabolite decreased 24%. |
If co-administering, monitor for excess sedation and adjust dose accordingly |
| Lenacapavir Methylprednisolone | 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). |
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| Lenacapavir Methadone | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Unknown effect on methadone |
If initiating methadone in a person already on lenacapavir, start with lowest feasible dose and titrate to clinical effect. If initiating lenacapavir in a person stable on methadone, dose adjustment of methadone may be required. Monitor for clinical efficacy and adverse effects (e.g. sedation, respiratory depression). |
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| Lenacapavir Mefloquine | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of mefloquine adverse effects |
If coadministering, monitor for mefloquine adverse effects (e.g. QT prolongation) |
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| Lenacapavir Lomitapide | Red: Avoid combination | Do not coadminister: potentially increased levels of lomitapide | Potential increased risk of lomitapide adverse effects |
Contraindicated. Use alternative agents |
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| Lenacapavir Fluticasone | 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 coadministering, initiate lowest starting dose and titrate to clinical effect. Monitor for adverse effects such as adrenal insufficiency and Cushing's syndrome. |
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| Lenacapavir Felodipine | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of felodipine adverse effects |
If coadministering, monitor for cardiac medication adverse effects (e.g. hypotension) |
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| Lenacapavir Everolimus | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of immunosuppressant adverse effects |
Initiate adjusted dose of immunosuppressant to account for increased concentration and follow up with therapeutic drug monitoring to refine dosing. Monitor for adverse effects of immunosuppressant. Consult with specialist as necessary. |
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| Lenacapavir Eplerenone | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of eplerenone adverse effects |
If coadministering in the setting of post-MI heart failure, eplerenone dose not to exceed 25 mg daily. If coadministered for hypertension, initiate eplerenone at 25mg daily. Dose not to exceed 25 mg twice daily. |
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| Lenacapavir Edoxaban | 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 edoxaban adverse effects (e.g. bleeding) |
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| Lenacapavir Dronedarone | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of dronedarone adverse effects |
Consider using alternative cardiac medication or ARV. If coadministering, monitor for dronedarone adverse effects. |
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| Lenacapavir Digoxin | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of digoxin adverse effects |
Use with caution and monitor digoxin therapeutic concentration |
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| Lenacapavir Diazepam | 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 diazepam adverse effects. |
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| Lenacapavir Darunavir/cobicistat | Green: Administer standard doses | Administer standard doses | No clinically significant effect expected |
AUC increased 94%; Cmax increased 130% |
800/150 mg once daily (in fed state) | Not reported |
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| Lenacapavir Daridorexant | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of excessive sedation |
If coadministering, maximum dose of daridorexant is 25 mg. |
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| Lenacapavir Cyclosporine | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of immunosuppressant adverse effects |
Initiate adjusted dose of immunosuppressant to account for increased concentration and follow up with therapeutic drug monitoring to refine dosing. Monitor for adverse effects of immunosuppressant. Consult with specialist as necessary. |
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| Lenacapavir Clopidogrel | Yellow: Adjust dosing | Minimal data to guide interaction: risks likely to outweigh benefits | Potential increased risk of bleeding |
Consider using alternative ARV or antiplatelet agents. If coadministering, monitor for clopidogrel-related adverse events (e.g. bleeding) |
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| Lenacapavir Buspirone | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of buspirone adverse effects |
If coadministering start with lowest dose and titrate to clinical effect. Monitor for buspirone-related adverse events. |
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| Lenacapavir Budesonide | 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 coadministering, initiate lowest starting dose and titrate to clinical effect. Monitor for adverse effects such as adrenal insufficiency and Cushing's syndrome. |
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| Lenacapavir Atazanavir/cobicistat | Red: Avoid combination | Do not coadminister: increased levels of atazanavir | Potential for increased atazanavir adverse effects (e.g. hyperbilirubinemia, gastrointestinal effects). |
AUC increased 321%; Cmax increased 560% |
300/150 mg daily (fed state) | Not reported |
Use alternative agents |
| Lenacapavir Artemether/Lumefantrine | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential increased risk of lumefantrine adverse effects |
If coadministering, monitor for lumefantrine adverse effects (e.g. QT prolongation) |
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| Lenacapavir Rifampin | Red: Avoid combination | Do not coadminister: decreased levels of lenacapavir | Potential decrease in antiretroviral efficacy |
AUC decreased 84%; Cmax decreased 55% |
600 mg daily (fasted) | Not reported |
Use alternative agents |
