Label
Interaction requires management
Color
Yellow
Yellow: Adjust dosing
| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Darunavir Tadalafil 890 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of tadalafil | Increased risk of tadalafil adverse effects (e.g. hypotension, priapism) |
Not studied |
Not studied (may increase tadalafil levels) |
For erectile dysfunction, initiate tadalafil 5 mg dose and do not exceed 10 mg every 72 hours. Monitor adverse effects. For patients taking a protease inhibitor (stable > 7 days) requiring tadalafil for pulmonary arterial hypertension, initiate 20 mg once daily and increase to 40 mg once daily based on tolerability. Patients currently on tadalafil who require a PI should stop tadalafil ³24 hours before PI initiation, take the PI for 7 days, then resume tadalafil at 20 mg. Maximum recommended daily dose for treatment of BPH is 2.5 mg daily. |
|
| Darunavir Sildenafil 889 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of sildenafil. (Do not coadminister for pulmonary hypertension) | Increased risk of sildenafil adverse effects (e.g. hypotension, priapism) |
Not reported |
25 mg x 1 | Cmax decrease 38% (compared to sildenafil 100 mg x 1 without darunavir / ritonavir) |
For erectile dysfunction, do not exceed sildenafil 25 mg every 48 hours and monitor for adverse effects. Contraindicated if using sildenafil for pulmonary arterial hypertension. |
| Darunavir Rosuvastatin 888 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rosuvastatin | Increased risk of rosuvastatin adverse effects (e.g. myopathy, rhabdomyolysis); No change in lipid lowering ability within 35 day study period |
No significant change |
10 mg once daily | Cmax increase 144%,AUC increase 48% |
Consider using alternative agents. If coadministering, consider initiating low dose rosuvastatin 5 mg daily |
| Darunavir Risperidone 887 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of risperidone | Potential for increased risk of risperidone adverse effects |
If coadministering, dose reduction may be necessary |
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| Darunavir RFB 886 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Increased darunavir and rifabutin effects. Note that lower rifabutin exposure has been reported in HIV- infected patients as compared to healthy study participants. |
Darunavir Cmax increase 42%, AUC increase 57%, Cmin increase 75%; Ritonavir Cmax increase 68%, AUC increase 66%, Cmin increase 31% |
150 mg every other day | Rifabutin: Cmax decrease 28%, AUC decrease 7%, Cmin increase 64%; 25-O-desacetylrifabutin: Cmax increase 377%, AUC increase 881%, Cmin increase 2610% |
Dose reduction of RFB by 75% of usual dose is recommended, such as rifabutin 150 mg every other day. Monitor for antimycobacterial activity and adverse events. Consider therapeutic drug monitoring. |
| Darunavir Pravastatin 885 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of pravastatin | Increased risk of pravastatin adverse effects (e.g. myopathy, rhabdomyolysis) |
Not studied |
40 mg x 1 | Cmax increase 63%, AUC increase 81% |
Use lowest possible starting dose, monitor for toxicity and titrate. |
| Darunavir MVC 884 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential for increased maraviroc adverse effects |
Not reported |
150 mg BID | Cmax increase 77%, AUC increase 210%, Cmin increase 427% |
Use maraviroc 150 mg BID when combined with darunavir / ritonavir |
| Darunavir MVC 883 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential for increased maraviroc adverse effects |
Not reported |
150 mg BID | Cmax increase 129%, AUC increase 305%, Cmin increase 700% |
Use maraviroc 150 mg BID when combined with darunavir / ritonavir |
| Darunavir Digoxin 882 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of digoxin | Increased risk of digoxin adverse effects |
Not reported |
0.4 mg x 1 | Cmax increase 15%, AUC increase 36% |
Initiate lowest dose digoxin and titrate to desired clinical effect |
| Darunavir Colchicine 881 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of colchicine | Increased risk of colchicine adverse effects |
For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose should not be repeated earlier than 3 days after. For gout prophylaxis, reduce colchicine dose to 0.3 mg daily if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg every other day if on 0.6 mg daily prior to PI therapy. For treatment of familial Mediterranean fever do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment. |
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| Darunavir Clarithromycin 880 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of clarithromycin | Increased risk of antibacterial adverse effects |
Cmax decrease 17%, AUC decrease 13%, Cmin increase 1% |
500 mg BID | Cmax increase 26%, AUC increased 57%, Cmin increase 174% |
In patients with CrCl 30-60 mL / min, reduce dose of clarithromycin by 50%. In patients with CrCl <30 mL / min, reduce clarithromycin dose by 75%. Monitor for clarithromycin-related toxicities and / or consider alternative macrolide. |
| Darunavir Brexpiprazole 879 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of brexpiprazole | Potential for increased risk of brexpiprazole adverse effects |
Administer 25% of the usual brexpiprazole dose. Titrate dose based on clinical monitoring for efficacy / adverse events. |
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| Darunavir Bosentan 878 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of bosentan | Potential for increased risk of bosentan adverse effects |
Start low and titrate bosentan to effect. If patient has been on protease inhibitor (other than unboosted atazanavir) for more than 10 days, start bosentan at 62.5 mg daily or every other day. If patient is currently on bosentan and requires a PI (other than unboosted atazanavir), stop bosentan for at least 36 hours prior to initiating ART. Wait 10 days and then resume bosentan starting with 62.5 mg daily or every other day. |
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| Darunavir Aripiprazole 877 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of aripiprazole | Potential for increased risk of aripiprazole adverse effects |
Administer 25% of the usual aripiprazole dose. Titrate dose based on clinical monitoring for efficacy / adverse events. |
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| Darunavir Iloperidone 876 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of iloperidone | Potential for increased risk of iloperidone adverse effects |
If coadministering, decrease dose of iloperidone by 50% |
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| Darunavir Fluvastatin 875 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of fluvastatin | Potential for increased risk of fluvastatin adverse effects |
Consider using alternative agents. If coadministering, initate lowest recommended dose and titrate while monitoring |
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| Darunavir Fesoterodine 874 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of fesoterodine | Potential for increased risk of zolpidem adverse effects |
If coadministering, do not exceed fesoterodine 4 mg once daily |
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| Darunavir Cariprazine 873 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of cariprazine | Potential for increased risk of cariprazine adverse effects |
If starting cariprazine in a patient on a protease inhibitor, administer cariprazine 1.5 mg on Day 1 and Day 3, with no dose given on Day 2. From Day 4 onward, administer cariprazine 1.5 mg daily. Dose may be increased to a maximum of cariprazine 3 mg daily. If starting a protease inhibitor for a patient already taking cariprazine 3-6mg, reduce dose by half. For patients taking cariprazine 4.5 mg daily, reduced cariprazine dose to 1.5 - 3 mg daily. For patients taking cariprazine 1.5 mg daily, reduce to cariprazine 1.5 mg every other day. If PI is withdrawn, cariprazine dose may need to be increased. |
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| Darunavir Calcifediol 872 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of calcifediol | Potential for increased risk of calcifediol adverse effects |
If coadministering, dose adjustment may be required. Monitor serum 25-hydroxyvitamin D, intact PTH, and serum calcium concentrations |
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| Darunavir Atorvastatin 871 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of atorvastatin | Increased risk of atorvastatin adverse effects (e.g. myopathy, rhabdomyolysis) |
Not reported |
40 mg once daily on days 1-4, then 10 mg once daily on days 4-7 | Cmax decrease 44%, AUC decrease 15%, Cmin increase 81% (10 mg daily with darunavir / ritonavir compared to atorvastatin 40 mg daily alone) |
Consider using alternative agents. If coadministering, consider low dose atorvastatin and doses < 20 mg. Monitor for myopathy |
| Darunavir Valproic Acid 870 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of valproic acid | Potential for decreased anticonvulsant effects |
Monitor anticonvulsant level and adjust accordingly |
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| Darunavir Omeprazole 869 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of omeprazole | Potential decreased omeprazole efficacy |
No significant change |
40 mg x 1 | Cmax decrease 34%, AUC decrease 42% |
Consider using alternative agents. If coadministering, monitor for omeprazole efficacy. If no symptomatic relief, increase dose to no more than 40 mg once daily |
| Darunavir Lamotrigine 868 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of lamotrigine | Potential for decreased anticonvulsant effects |
Monitor anticonvulsant level and adjust accordingly |
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| Darunavir Canagliflozin 867 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of canagliflozin | Potential for decreased glucose lowering effect |
If a patient is already tolerating canagliflozin 100 mg daily, increase canagliflozin dose to 200 mg daily. If a patient is already tolerating canagliflozin 200 mg daily and requires additional glycemic control, management strategy is based on renal function, 300 mg if eGFR>60 or add another agent if eGFR<60 |
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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 |
| Atazanavir Methadone 801 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Potential decreased methadone effects (withdrawl, inadequate pain control, cravings) |
stable dose on d 1-15 | Total methadone Cmax decresed 15% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
|
| Atazanavir Lamotrigine 800 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of lamotrigine | Atazanavir with ritonavir may decrease lamotrigine plasma concentrations, Atazanavir without ritonavir is most likely not clinically significant |
No significant change |
100 mg daily | AUC decreased 32% |
No dose adjustment necessary if administering lamotrigine and atazanavir alone. If administering lamotrigine and atazanavir plus ritonovir, lamotrigine maintenance dose may need to be increased. |
| Atazanavir EE/NGM 799 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of hormonal contraception | Ethinyl estradiol AUC decreased 19%, Cmax decreased 16%, Cmin decreased 37% 17-deacetyl norgestimate AUC increased 85%, Cmax increased 68%, Cmin increased 102% |
With ritonavir boosted atazanavir, use an oral contraceptive containing at least 35 mcg of ethinyl estradiol. Oral contraceptives containing progestins other than norethindrone or norgestimate have not been studied. |
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| Atazanavir Famotidine 798 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | No significant change |
20 mg BID on d 11-17 (simultaneous administration with morning atazanavir / ritonavir) | Unboosted atazanavir: administer dose 2 hrs before or 10 hours after the H2-blocker. H2 blocker single dose should not exceed 20 mg famotidine and total daily dose should not exceed 40 mg famotidine (treatment naive patients). Ritonavir or cobicistat boosted atazanavir: administer dose simultaneously with or > 10 hours after H2 blocker. Do not exceed H2 blocker doses of 80 mg famotidine daily (treatment naive) or 40 mg famotidine daily (treatment experienced). If using in a treatment-experienced patient who is also on TDF, increase atazanavir dose to 400 mg with boosting. |
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| Atazanavir Famotidine 797 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC no significant change, Cmax no significant change, Cmin decreased 14%(compared to 300 mg atazanavir with 100 mg ritonavir daily) |
40 mg Q12H on d 11-20 | Unboosted atazanavir: administer dose 2 hrs before or 10 hours after the H2-blocker. H2 blocker single dose should not exceed 20 mg famotidine and total daily dose should not exceed 40 mg famotidine (treatment naive patients). Ritonavir or cobicistat boosted atazanavir: administer dose simultaneously with or > 10 hours after H2 blocker. Do not exceed H2 blocker doses of 80 mg famotidine daily (treatment naive) or 40 mg famotidine daily (treatment experienced). If using in a treatment-experienced patient who is also on TDF, increase atazanavir dose to 400 mg with boosting. |
|
| Atazanavir Famotidine 796 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir Cmin decreased 31% |
40 mg daily on d 7-12 | Unboosted atazanavir: administer dose 2 hrs before or 10 hours after the H2-blocker. H2 blocker single dose should not exceed 20 mg famotidine and total daily dose should not exceed 40 mg famotidine (treatment naive patients). Ritonavir or cobicistat boosted atazanavir: administer dose simultaneously with or > 10 hours after H2 blocker. Do not exceed H2 blocker doses of 80 mg famotidine daily (treatment naive) or 40 mg famotidine daily (treatment experienced). If using in a treatment-experienced patient who is also on TDF, increase atazanavir dose to 400 mg with boosting. |
|
| Atazanavir Famotidine 795 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 41%, Cmax decreased 47%, Cmin decreased 42% |
40 mg BID on d 7-12 | Unboosted atazanavir: administer dose 2 hrs before or 10 hours after the H2-blocker. H2 blocker single dose should not exceed 20 mg famotidine and total daily dose should not exceed 40 mg famotidine (treatment naive patients). Ritonavir or cobicistat boosted atazanavir: administer dose simultaneously with or > 10 hours after H2 blocker. Do not exceed H2 blocker doses of 80 mg famotidine daily (treatment naive) or 40 mg famotidine daily (treatment experienced). If using in a treatment-experienced patient who is also on TDF, increase atazanavir dose to 400 mg with boosting. |
|
| Atazanavir Famotidine 794 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 41% |
20 mg BID on d 11-17 | Unboosted atazanavir: administer dose 2 hrs before or 10 hours after the H2-blocker. H2 blocker single dose should not exceed 20 mg famotidine and total daily dose should not exceed 40 mg famotidine (treatment naive patients). Ritonavir or cobicistat boosted atazanavir: administer dose simultaneously with or > 10 hours after H2 blocker. Do not exceed H2 blocker doses of 80 mg famotidine daily (treatment naive) or 40 mg famotidine daily (treatment experienced). If using in a treatment-experienced patient who is also on TDF, increase atazanavir dose to 400 mg with boosting. |
|
| Atazanavir Famotidine 793 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 38%, Cmax decreased 42%, Cmin decreased 40% |
40 mg Q12H | Not reported |
Unboosted atazanavir: administer dose 2 hrs before or 10 hours after the H2-blocker. H2 blocker single dose should not exceed 20 mg famotidine and total daily dose should not exceed 40 mg famotidine (treatment naive patients). Ritonavir or cobicistat boosted atazanavir: administer dose simultaneously with or > 10 hours after H2 blocker. Do not exceed H2 blocker doses of 80 mg famotidine daily (treatment naive) or 40 mg famotidine daily (treatment experienced). If using in a treatment-experienced patient who is also on TDF, increase atazanavir dose to 400 mg with boosting. |
| Atazanavir Famotidine 792 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 18%, Cmax no significant change, Cmin decreased 28% |
40 mg BID on d 11-20 | Not reported |
Unboosted atazanavir: administer dose 2 hrs before or 10 hours after the H2-blocker. H2 blocker single dose should not exceed 20 mg famotidine and total daily dose should not exceed 40 mg famotidine (treatment naive patients). Ritonavir or cobicistat boosted atazanavir: administer dose simultaneously with or > 10 hours after H2 blocker. Do not exceed H2 blocker doses of 80 mg famotidine daily (treatment naive) or 40 mg famotidine daily (treatment experienced). If using in a treatment-experienced patient who is also on TDF, increase atazanavir dose to 400 mg with boosting. |
| Atazanavir EFV 791 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir (all values compared to atazanavir 400 mg daily) AUC decreased 21%, Cmax no significant change, Cmin decreased 59% |
600 mg daily on days 7-20 | Not reported |
In ART-naive patients standard dose efavirenz may be used with atazanavir 400 mg boosted with ritonavir 100 mg once daily. Do not coadminister efavirenz plus ritonavir-boosted atazanavir in ART-experienced patients. Do not coadminister efavirenz with unboosted atazanavir. |
| Atazanavir EFV 790 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 74%, Cmax decreased 59%, Cmin decreased 93%, half-life: decreased 27% |
600 mg daily on days 7-20 | No significant change |
In ART-naive patients standard dose efavirenz may be used with atazanavir 400 mg boosted with ritonavir 100 mg once daily. Do not coadminister efavirenz plus ritonavir-boosted atazanavir in ART-experienced patients. Do not coadminister efavirenz with unboosted atazanavir. |
| Atazanavir EFV 789 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential for increased atazanavir adverse effects |
Atazanavir AUC increased 241%, Cmax increased 124%, Cmin increased 671%, half-life: increased 79% |
600 mg daily with ritonavir 200 mg on days 15-28 | Not reported |
In ART-naive patients standard dose efavirenz may be used with atazanavir 400 mg boosted with ritonavir 100 mg once daily. Do not coadminister efavirenz plus ritonavir-boosted atazanavir in ART-experienced patients. Do not coadminister efavirenz with unboosted atazanavir. |
| Atazanavir EFV 788 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential for increased atazanavir adverse effects |
Atazanavir (all values compared to atazanavir 400 mg daily) AUC increased 39% , Cmax no significant change, Cmin increased 48% |
600 mg daily x days 7-20 | Not reported |
In ART-naive patients standard dose efavirenz may be used with atazanavir 400 mg boosted with ritonavir 100 mg once daily. Do not coadminister efavirenz plus ritonavir-boosted atazanavir in ART-experienced patients. Do not coadminister efavirenz with unboosted atazanavir. |
| Atazanavir Rabeprazole 787 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Pantoprazole 786 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Lansoprazole 785 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 94%, Cmax decreased 91%, half-life: no significant change |
60 mg daily x 2 doses | Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Omeprazole 784 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 94%, Cmax decreased 96%, Cmin decreased 95% |
40 mg daily x 5 d | Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Omeprazole 783 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 76%, Cmax decreased 72%, Cmin decreased 78% |
40 mg daily x 10 d | Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Omeprazole 782 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 70%, Cmax decreased 66%, Cmin decreased 76% |
40 mg daily x 10 d | Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Omeprazole 781 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 61%, Cmax decreased 56%, Cmin decreased 66% |
40 mg daily x 10 d | Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Omeprazole 780 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 42%, Cmax decreased 39%, Cmin decreased 46% |
20 mg daily on d 17-23 | Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Omeprazole 779 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Atazanavir AUC decreased 30%, Cmin decreased 31%, Cmax decreased 31% |
20 mg daily on d 17-23 | Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Omeprazole 778 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Increased omeprazole effects |
Not reported |
40 mg x 1 on d 7 and 20 | Omeprazole AUC increased 45%, Cmax increased 24% |
Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
| Atazanavir Esomeprazole 777 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy |
Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir if boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients. |
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| Atazanavir Pantoprazole 776 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Administer proton pump inhibitor at least 12 hours before atazanavir / cobicistat. Proton pump inhibitors should not exceed a dose equivalent to omeprazole 20 mg daily in protease inhibitor naive patients. Proton pump inhibitors are not recommended in protease inhibitor experienced patients. |
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| Atazanavir TDF 775 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of atazanavir | Potential loss of antiretroviral efficacy with lower atazanavir concentrationss. Potential for increased tenofovir adverse effects |
Atazanavir Cmax decreased 28%, AUC decreased 25%, Cmin decreased 26%, Ritonavir Cmax decreased 28%, AUC decreased 25%, Cmin no significant change |
300 mg daily on days 15-42 | Not reported |
Administer 300 mg atazanavir with 100 mg ritonavir when used as part of a tenofovir containing regimen. Do not coadminister TDF with unboosted atazanavir (400 mg). |
| Atazanavir Cimetidine 774 | Yellow: Adjust dosing | Adjust dosing to avoid reduced atazanavir levels | Potential loss of antiviral efficacy |
Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat. |
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| Atazanavir Bosentan 773 | Yellow: Adjust dosing | Adjust dosing to avoid reduced atazanavir levels | Potential decreased antiviral effects of atazanavir |
Do not coadminister bosentan with unboosted atazanavir, For patients receiving atazanavir plus ritonavir for >10 days, start bosentan at 62.5mg daily or every other day based on individual tolerability, Discontinue bosentan at least 36 hours before starting atazanavir / ritonavir. At least 10 days after starting atazanavir / ritonavir, resume bosentan at 62.5mg daily or every other day based on individual tolerability. |
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| Atazanavir Aluminum and magnesium hydroxide antacid 772 | Yellow: Adjust dosing | Adjust dosing to avoid reduced atazanavir levels | Separate administration of atazanavir / cobicistat and antacids by a minimum of 2 hours. |
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| Atazanavir Tadalafil 771 | Yellow: Adjust dosing | Adjust dosing to avoid increased tadalafil levels | Potentially increased tadalafill effects (eg, hypotension, priapism) |
For erectile dysfunction initiate tadalafil 5 mg dose and do not exceed 10 mg every 72 hours. Monitor adverse effects. For patients taking a protease inhibitor (stable > 7 days) requiring tadalafil for pulmonary arterial hypertension initiate 20 mg once daily and increase to 40 mg once daily based on tolerability. Patients currently on tadalafil who require a PI should stop tadalafil ³24 hours before PI initiation, take the PI for 7 days, then resume tadalafil at 20 mg. Maximum recommended daily dose for treatment of BPH is 2.5 mg daily. |
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| Atazanavir Sildenafil 770 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of sildenafil. (Do not coadminister for pulmonary hypertension) | Potentially increased sildenafil effects (eg, hypotension, priapism) |
For erectile dysfunction, initiate sildenafil (Viagra) 25 mg every 48 hours and monitor for adverse effects. Do not coadminister if using sildenafil for pulmonary arterial hypertension. |
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| Atazanavir Rosuvastatin 769 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rosuvastatin | Potential for increased rosuvastatin adverse effects (e.g. myopathy) |
10 mg daily | Rosuvastatin AUC increased 213%, Cmax increased 600% |
Initiate lowest dose and titrate carefully. Do not exceed 10mg rosuvastatin daily. |
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| Atazanavir RFB 768 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Atazanavir Cmax increased 34% |
150 mg daily on days 15-28 | Not reported |
Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring. |
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| Atazanavir RFB 767 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Potential increase in atazanavir adverse effects |
Atazanavir AUC increased 191%, Cmax increased 81% |
150 mg daily on days 15-28 | Not reported |
Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring. |
| Atazanavir RFB 766 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rifabutin | Increased rifabutin effects (eg, uveitis) |
Not reported |
300 mg daily on days 1-10, then 150 mg daily on days 11-20 | Rifabutin AUC increased 110%, Cmax increased 118%, Cmin increased 243%, 25-O-desacetylrifabutin AUC increased 2101%, Cmax increased 720%, Cmin increased 7460% |
Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring. |
| Atazanavir Pitavastatin 765 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of pitavastatin | Potential for increased pitavastatin adverse effects |
No significant change |
4 mg daily | Pitavastatin AUC increased 31%, Cmax increased 60% |
Start at lowest dose and titrate to effect |
| Atazanavir MVC 764 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential increase in maraviroc adverse effects |
Not reported |
300 mg BID | Maraviroc AUC increased 388%, Cmax increased 167%, Cmin increased 567% |
Decrease maraviroc dose to 150 mg BID |
| Atazanavir MVC 763 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential increase in maraviroc adverse effects |
Not reported |
300 mg BID | Maraviroc AUC increased 257%, Cmax increased 109%, Cmin increased 319% |
Decrease maraviroc dose to 150 mg BID |
| Atazanavir Itraconazole 762 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of itraconazole | Unless guided by therapeutic drug monitoring, limit doses of itraconazole to less than 200 mg daily when used with atazanavir / cobicistat. |
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| Atazanavir Ethinyl estradiol / Norethindrone acetate 761 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of hormonal contraception | Increased norethindrone and ethinyl estradiol effects |
1 tab daily (7 / 7 / 7) | Norethindrone Cmax increased 67%, AUC increased 110%, Cmin increased 262%, Ethinyl estradiol AUC increased 48%, Cmax no significant change, Cmin increased 91% |
For unboosted atazanavir, use an oral contraceptive that contains no more than 30 mcg of ethinyl estradiol or recommend an alternative contraceptive method. Oral contraceptives containing less than 25mcg of ethinyl estradiol or progestins other than norethindrone or norgestimate have not been studied. |
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| Atazanavir Diltiazem 760 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of diltiazem | Potential for increased diltiazem effects (eg, hypotension, heart block) |
No significant change |
180 mg daily on days 7-11 and 19-23 | Diltiazem AUC increased 125%, Cmax increased 198%, Cmin decreased 59% |
Reduce diltiazem dose by 50%. ECG monitoring is recommended. |
| Atazanavir Daclatasvir 759 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of daclatasvir | No significant change |
20 mg daily | AUC(tau) increased 110% |
Decrease daclatasvir dose to 30 mg daily when used with atazanavir / ritonavir. No dose adjustment necessary if used with unboosted atazanavir. |
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| Atazanavir Daclatasvir 758 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of daclatasvir | Decrease daclatasvir dose to 30 mg daily |
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| Atazanavir Colchicine 757 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of colchicine | Potential for increased colchicine effects |
For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose should not be repeated earlier than 3 days after. For gout prophylaxis, reduce colchicine dose to 0.3 mg daily if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg every other day if on 0.6 mg daily prior to PI therapy. For treatment of familial Mediterranean fever do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment. |
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| Atazanavir Clarithromycin 756 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of clarithromycin | Potential for increased clarithromycin effects. (e.g. may cause QTc prolongation). |
Atazanavir AUC increased 28%, Cmax no significant change, Cmin increased 91% |
500 mg BID on days 7-11 and 18-21 | Clarithromycin AUC increased 94%, Cmax increased 50%, Cmin decreased 62%, 14-hydroxyclarithromycin AUC decreased 70%, Cmax decreased 72%, Cmin increased 164% |
Reduce clarithromycin dose by 50% |
| Atazanavir RTV 755 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of atazanavir | Increased atazanavir effects |
Atazanavir AUC increased 238%; Cmax increased 86%; Cmin increased 1089% |
100 mg daily on days 11-20 | Not studied |
Dose atazanavir 300 mg once daily with ritonavir 100 mg daily |
| Atazanavir DRV 754 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of antiretrovirals | Atazanavir Cmin increased 52% |
400 mg BID with ritonavir 100 mg BID | No significant change |
If used in combination, atazanavir may be given in conjunction with darunavir / ritonavir at study doses (300mg daily plus 400 / 100 mg daily) |
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| Tenofovir disoproxil fumarate ATV/c 729 | Yellow: Adjust dosing | Adjust dosing to avoid altered levels of atazanavir and TDF | Potentially increased risk of TDF adverse effects and decreased efficacy of atazanavir |
Not studied (may increase TDF levels) |
Not studied (may decrease atazanavir levels) |
If coadministering atazanavir, cobicistat, tenofovir, and an H2 receptor antagonist in a treatment-experienced patient, increase atazanavir dose to 400 mg |
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| Tenofovir disoproxil fumarate ATV 728 | Yellow: Adjust dosing | Adjust dosing to avoid altered levels of atazanavir and TDF | Increased tenofovir effects, decreased atazanavir effects |
Cmax increase 34%, AUC increase 37%, Cmin increase 29% |
300 mg once daily with 100 mg ritonavir daily | Cmax decrease 28%, AUC decrease 25%, Cmin decrease 23% |
Do not coadminister with unboosted atazanavir (400 mg). Administer 300 mg atazanavir with 100 mg ritonavir when used as part of a tenofovir containing regimen. If coadministering atazanavir, ritonavir, tenofovir, and an H2 receptor antagonist in a treatment-experienced patient, increase atazanavir dose to 400 mg (plus 100 mg ritonavir). |
| Tenofovir disoproxil fumarate ATV 727 | Yellow: Adjust dosing | Adjust dosing to avoid altered levels of atazanavir and TDF | Increased tenofovir effects, decreased atazanavir effects |
Cmax increase 14%, AUC increase 24%, Cmin increase 22% |
400 mg once daily with a light meal | Cmax decrease 21%, AUC decrease 25%, Cmin decrease 40% |
Do not coadminister with unboosted atazanavir (400 mg). Administer 300 mg atazanavir with 100 mg ritonavir when used as part of a tenofovir containing regimen. If coadministering atazanavir, ritonavir, tenofovir, and an H2 receptor antagonist in a treatment-experienced patient, increase atazanavir dose to 400 mg (plus 100 mg ritonavir). |
| Tenofovir disoproxil fumarate ATV 726 | Yellow: Adjust dosing | Adjust dosing to avoid altered levels of atazanavir and TDF | Increased atazanavir and tenofovir effects |
Cmax increase 39%, AUC increase 55%, Cmin increase 70% |
400 mg once daily with 100 mg ritonavir daily | Cmax increase 31%, AUC increase 38%, Cmin increase 33% |
Do not coadminister with unboosted atazanavir (400 mg). Administer 300 mg atazanavir with 100 mg ritonavir when used as part of a tenofovir containing regimen. If coadministering atazanavir, ritonavir, tenofovir, and an H2 receptor antagonist in a treatment-experienced patient, increase atazanavir dose to 400 mg (plus 100 mg ritonavir). |
| Abacavir Methadone 666 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Potential for decreased methadone effects (e.g., withdrawal) |
No significant change |
40 mg once daily; 90 mg once daily | Methadone clearance increased 22% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Rilpivirine Famotidine 646 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rilpivirine | Decreased rilpivirine effects |
Rilpivirine AUC decreased 76%; Cmax decreased 85% |
40 mg x 1 taken 2 hours before rilpivirine | Administer H2-antagonist by at least 12 hours before rilpivirine or at least 4 hours after rilpivirine. |
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| Rilpivirine Aluminum and magnesium hydroxide antacid 645 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rilpivirine | Potentially decreased rilpivirine effects |
Administer antacids either at least 2 hours before or at least 4 hours after rilpivirine. |
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| Rilpivirine Methadone 644 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Potentially decreased methadone effects (eg, withdrawal) |
No significant change |
60-100 mg daily | R-methadone AUC decreased 16%; Cmin decreased 22%; S-methadone AUC decreased 16%; Cmin decreased 21%; |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Nevirapine Methadone 583 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
stable dose: racemic methadone 35-220 mg daily; (R)-methadone 45-115 mg daily | racemic methadone AUC decreased 37%; (R)-methadone AUC decreased 44% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
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| Nevirapine Methadone 582 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, methadone withdrawal; interaction observed one week into therapy |
Nevirapine AUC increased 26%; Cmax increased 21%; Cmin increased 35% |
Stable methadone maintenance | Methadone AUC decreased 46% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Nevirapine Methadone 581 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, methadone withdrawal) |
Nevirapine AUC increased 25%; Cmax increased 17%; Cmin increased 32% |
Stable methadone dose | Methadone AUC decreased 51%; Cmax decreased 36% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Nevirapine Methadone 580 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects |
Nevirapine AUC decreased 46%; Cmax decreased 42% |
stable dose | Not reported |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose |
| Nevirapine IDV 579 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of indinavir | Decreased indinavir effects |
800 mg Q8H | Indinavir AUC decreased 31%; Cmax decreased 15%, Cmin decreased 44% |
Increase indinavir to 1000 mg Q8H |
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| Nevirapine FPV 578 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of fosamprenavir | Not studied |
700 mg fosamprenavir BID with 100 mg ritonavir BID | No significant change |
Do not use with fosamprenavir alone. Ritonavir boosted fosamprenavir (700 / 100 mg BID) can be considered |
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| Nevirapine FPV 577 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of fosamprenavir | Decreased fosamprenavir effects |
Nevirapine AUC decreased 46%; Cmax decreased 42% |
1400 mg BID | Fosamprenavir AUC decreased 33%; Cmax decreased 25%; Cmin decreased 35% |
Do not use with fosamprenavir alone. Ritonavir boosted fosamprenavir (700 / 100 mg BID) can be considered |
| Nevirapine Daclatasvir 576 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of daclatasvir | Potential loss of anti-HCV efficacy |
Nevirapine Cmin decreased 16% |
Not studied (may decrease daclatasvir levels) |
Increase daclatasvir dose to 90 mg daily. |
|
| Nevirapine Daclatasvir 575 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of daclatasvir | Potential loss of anti-HCV efficacy |
120 mg daily | AUC increased 37% and Cmin decreased 17%. |
Increase daclatasvir dose to 90 mg daily. |
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| Etravirine RFB 520 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
Etravirine AUC decreased 37%; Cmax decreased 37%; Cmin decreased 35% |
300 mg daily | Rifabutin AUC decreased 17%; Cmin decreased 24%; 25-O-desacetylrifabutin AUC decreased 17%; Cmax decreased 15%; Cmin decreased 22% |
Administer rifabutin 300 mg once daily with etravirine. If etravirine and a protease inhibitor are used together, do not coadminister with rifabutin. |
| Etravirine MVC 519 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of maraviroc | No significant change |
300 mg BID | Maraviroc AUC decreased 53%; Cmax decreased 60%; Cmin decreased 39% |
Increase maraviroc to 600 mg BID when combined with etravirine. When etravirine and maraviroc are coadministered with a strong CYP3A4 inhibitor, decrease maraviroc dose to 150 mg BID |
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| Etravirine MVC 518 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of maraviroc | Increased maraviroc effects |
150 mg BID | Maraviroc AUC increased 3.10 fold; Cmax increased 1.76 fold; Cmin increased 5.27 fold |
Increase maraviroc to 600 mg BID when combined with etravirine. When etravirine and maraviroc are coadministered with a strong CYP3A4 inhibitor, decrease maraviroc dose to 150 mg BID |
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| Etravirine MVC 517 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of maraviroc | Increased maraviroc effects |
No significant change on etravirine, darunavir or ritonavir pharmacokinetics |
300 mg BID | Maraviroc AUC increased 210%; Cmax increased 77%; Cmin increased 430% |
Increase maraviroc to 600 mg BID when combined with etravirine. When etravirine and maraviroc are coadministered with a strong CYP3A4 inhibitor, decrease maraviroc dose to 150 mg BID |
| Etravirine MVC 516 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of maraviroc | Decreased maraviroc effects |
300 mg BID | Maraviroc AUC decreased 53%; Cmax decreased 60%; Cmin decreased 39% |
Increase maraviroc to 600 mg BID when combined with etravirine. When etravirine and maraviroc are coadministered with a strong CYP3A4 inhibitor, decrease maraviroc dose to 150 mg BID |
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| Etravirine Daclatasvir 515 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of daclatasvir | Potential loss of anti-HCV efficacy |
Not studied |
120 mg daily | AUC increased 37% and Cmin decreased 17%. |
Increase daclatasvir dose to 90 mg daily. |
| Etravirine Atorvastatin 514 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of atorvastatin | Decreased atorvastatin effects |
No significant change |
40 mg daily | Atorvastatin AUC decreased 37% 2-hydroxyatorvastatin AUC increased 27%; Cmax increased 76% |
Consider low dose atorvastatin and titrate to effect; monitor for myopathy |
| Etravirine RTV 513 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of etravirine | Significant decrease in etravirine concentration and loss of theraputic effect |
600 mg BID | |||
| Efavirenz Voriconazole 387 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Efavirenz AUC increased 17%; Cmax no significant change |
400 mg Q12H on days 2-7 | Voriconazole Cmax increased 23% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
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| Efavirenz Voriconazole 386 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Efavirenz AUC increased 17%; Cmax no significant change |
400 mg Q12H on days 2-7 | Voriconazole Cmax increased 23% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
