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 | |
|---|---|---|---|---|---|---|---|
| Efavirenz Voriconazole 385 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavirenz AUC increased 17%; Cmax no significant change |
400 mg Q12H on days 2-7 | Voriconazole Cmax increased 23%, AUC decreased 7% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 384 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavrenz AUC increased 44%; Cmax increased 38% |
400 mg PO Q12H on day 1, then 200 mg Q12H on days 2-8 | Voriconazole AUC decreased 77%; Cmax decreased 61% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 383 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavrenz AUC increased 44%; Cmax increased 38% |
400 mg PO Q12H on day 1, then 200 mg Q12H on days 2-8 | Voriconazole AUC decreased 77%; Cmax decreased 61% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 382 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Increased efavirenz effects and decreased voriconazole effects |
Efavrenz AUC increased 44%; Cmax increased 38% |
400 mg PO Q12H on day 1, then 200 mg Q12H on days 2-8 | Voriconazole AUC decreased 77%; Cmax decreased 61% |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 381 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Decreased voriconazole effects |
No significant change |
300 mg Q12H on days 2-7 | Voriconazole AUC decreased 55%; Cmax decreased 36% (compared to voriconazole 200 mg BID) |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 380 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Decreased voriconazole effects |
No significant change |
300 mg Q12H on days 2-7 | Voriconazole AUC decreased 55%; Cmax decreased 36% (compared to voriconazole 200 mg BID) |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Voriconazole 379 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of voriconazole and increased levels of efavirenz | Decreased voriconazole effects |
No significant change |
300 mg Q12H on days 2-7 | Voriconazole AUC decreased 55%; Cmax decreased 36% (compared to voriconazole 200 mg BID) |
Increase voriconazole to 400 mg Q12H and decrease efavirenz to 300 mg QHS |
| Efavirenz Simvastatin 378 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of simvastatin | Decreased simvastatin effects |
No significant change |
40 mg daily x 4 days | Simvastatin AUC decreased 68%; Cmax decreased 72%; Cmin decreased 45% |
Monitor statin efficacy. May need to increase simvastatin dose |
| Efavirenz Simvastatin 377 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of simvastatin | Decreased lipid effects |
No significant change |
40 mg daily on days 0-3 and 15-18 | Simvastatin AUC decreased 58% |
Monitor statin efficacy. May need to increase simvastatin dose |
| Efavirenz RFB 376 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Not studied |
600 mg twice weekly | Rifabutin AUC no significant change; Cmax no significant change (when compared to rifabutin 300 mg twice weekly without efavirenz) |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
|
| Efavirenz RFB 375 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Potential decreased rifabutin effects |
Not studied |
300 mg or 450 mg twice weekly | On 300 mg rifabutin twice weekly, rifabutin level 2 hours after dose: no significant change; rifabutin level 6 hours post dose: decreased 27%; on 450 mg twice weekly, rifabutin level 2 hours post dose: no significant change; rifabutin level 6 hours post dose: decreased 58%(all values compared to rifabutin alone) |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Efavirenz RFB 374 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
No significant change |
300 mg daily x 14 days | Rifabutin AUC decreased 38%; Cmax decreased 32%; Cmin decreased 45% |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Efavirenz RFB 373 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
No significant change |
300 mg daily x 14 days | Rifabutin AUC decreased 38%; Cmax decreased 32%; Cmin decreased 45% |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Efavirenz RFB 372 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of rifabutin | Decreased rifabutin effects |
No significant change |
300 mg daily x 14 days | Rifabutin AUC decreased 38%; Cmax decreased 32% |
Increase rifabutin to 450-600 mg daily. May use rifabutin 300 mg three times weekly if not coadministered with a protease inhibitor |
| Efavirenz Pravastatin 371 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of pravastatin | Decreased pravastatin effects |
No significant change |
40 mg daily x 4 days | Pravastatin AUC decreased 44%; Cmax decreased 32%; Cmin decreased 19% |
Monitor statin efficacy. May need to increase pravastatin dose |
| Efavirenz Pravastatin 370 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of pravastatin | Decreased lipid effects |
No significant change |
40 mg daily on days 0-3 and 15-18 | Pravastatin AUC decreased 40% |
Monitor statin efficacy. May need to increase pravastatin dose |
| Efavirenz Methadone 369 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
stable dose over period of 60 weeks | Methadone AUC decreased 39%; Cmax decreased 33%; Cmin decreased 44%EDDP (methadone metabolite) AUC decreased 14.5%; Cmax no significant change; Cmin no significant change |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 368 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
Not studied |
Methadone AUC decreased 57%; Cmax decreased 48% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 367 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
35-100 mg daily | Methadone AUC decreased 52%; Cmax decreased 45% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 366 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
35-100 mg daily | Methadone AUC decreased 52%; Cmax decreased 45% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz Methadone 365 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of methadone | Decreased methadone effects (eg, withdrawal) |
35-100 mg daily | Methadone AUC decreased 52%; Cmax decreased 45% |
If coadministering monitor for signs and symptoms of methadone withdrawal. Some patients may require an increased methadone dose. In one study patients required mean dose increase of 30% over period of 60 weeks. |
|
| Efavirenz MVC 364 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of maraviroc | Decreased maraviroc effects |
100 mg BID | Maraviroc AUC decreased 45%; Cmax decreased 51%; Cmin decreased 45% |
Increase maraviroc dose to 600 mg BID |
|
| Efavirenz MVC 363 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of maraviroc | Decreased maraviroc effects |
100 mg BID | Maraviroc AUC decreased 45%; Cmax decreased 51%; Cmin decreased 45% |
Increase maraviroc dose to 600 mg BID |
|
| Efavirenz DTG 362 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potentially reduced dolutegravir effectiveness |
50 mg daily | Dolutegravir AUC decreased 57%; Cmin decreased 75% |
If no INSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative combination |
|
| Efavirenz Daclatasvir 361 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of daclatasvir | Potential loss of anti-HCV efficacy |
120 mg daily | Daclatasvir Cmax increased 67%; AUC increased 37%. |
Increase daclatasvir dose to 90 mg daily. |
|
| Efavirenz Fluvastatin 360 | Yellow: Adjust dosing | adjust dosing to avoid increased levels of fluvastatin | Potential for increased levels of fluvastatin |
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| Cabotegravir Aluminum and magnesium hydroxide antacid 326 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of cabotegravir | Not studied |
Not studied |
Administer antacids by at least 2 hours before or 4 hours after oral CAB |
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| Raltegravir RFB 285 | Yellow: Adjust dosing | Administer standard doses | Raltegravir AUC increased 19%; Cmax increased 39%; Cmin decreased 20% |
300 mg daily x 14 d | |||
| Raltegravir RPT 284 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of raltegravir | Raltegravir AUC increased 73%; Cmax increased 89%; Cmin decreased 44% |
900 mg PO once weekly | When coadministering with once weekly rifapentine use raltegravir 400 mg BID. Do not coadminister raltegravir with once daily rifapentine. |
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| Raltegravir RIF 283 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of raltegravir | Raltegravir AUC increased 27%; Cmin decreased 53%; Cmax increased 62% (compared to 400 mg raltegravir Q12H when given alone) |
600 mg daily | Dose raltegravir 800 mg orally twice daily. Do not coadminister raltegravir 1200 mg once daily with rifampin. |
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| Raltegravir RIF 282 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of raltegravir | Potential decrease in antiretroviral efficacy |
Raltegravir AUC increased 27%; Cmax increased 62%; Cmin decreased 53% (all compared to raltegravir 400 mg BID) |
600 mg daily | Not reported |
Dose raltegravir 800 mg orally twice daily. Do not coadminister raltegravir 1200 mg once daily with rifampin. |
| Raltegravir RIF 281 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of raltegravir | Potential decrease in antiretroviral efficacy |
Raltegravir AUC decreased 40%; Cmax decreased 38%; Cmin decreased 61% |
600 mg daily | Not reported |
Dose raltegravir 800 mg orally twice daily. Do not coadminister raltegravir 1200 mg once daily with rifampin. |
| Elvitegravir Vardenafil 177 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of vardenafil | Potential for increased vardenafil effects (e.g. hypotension, priapism) |
Initiate vardenafil 2.5 mg every 72 hours and monitor for adverse effects |
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| Elvitegravir Trazodone 176 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of trazodone | Potential for increased trazodone adverse effects |
If coadministering initiate trazodone at lowest dose. Monitor response and titrate according to efficacy, adverse effects. |
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| Elvitegravir Thioridazine 175 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of thioridazine | Potential for increased risk of thioridazine adverse effects |
Initiate lowest starting dose or decrease current dose of antipsychotic. Monitor efficacy and adverse effects. |
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| Elvitegravir Terazosin 174 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of terazosin | Potential for increased terazosin adverse effects |
Initiate low dose terazosin and titrate dose according to efficacy and adverse effects. |
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| Elvitegravir Tadalafil 173 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of tadalafil | Potential for increased tadalafil effects (e.g. 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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| Elvitegravir Sildenafil 172 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of sildenafil. | Potential for increased sildenafil effects (eg, hypotension, priapism, visual disturbances) |
For erectile dysfunction, initiate sildenafil 25 mg every 48 hours and monitor for adverse effects. Manufacturer recommends not to exceed dose of 25 mg every 48 hours. Do not coadminister if using sildenafil for pulmonary arterial hypertension. |
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| Elvitegravir Risperidone 171 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of risperidone | Potential for increased risk of risperidone adverse effects |
Initiate lowest starting dose or decrease current dose of antipsychotic. Monitor efficacy and adverse effects. |
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| Elvitegravir Pimavanserin 170 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of pimavanserin | Potential for increased risk of nefazodone adverse effects |
Reduce pimavanserin dose to 10 mg |
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| Elvitegravir Perphenazine 169 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of perphenazine | Potential for increased risk of perphenazine adverse effects |
Initiate lowest starting dose or decrease current dose of antipsychotic. Monitor efficacy and adverse effects. |
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| Elvitegravir Paroxetine 168 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of paroxetine | Potential for increased risk of paroxetine adverse effects |
If coadministering initiate paroxetine at lowest dose. Monitor response and titrate dose according to efficacy and adverse effects. |
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| Elvitegravir Nortriptyline 167 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of nortriptyline | Potential for increased risk of nortriptyline adverse effects |
If coadministering initiate nortriptyline at lowest dose. Monitor response and titrate according to efficacy and adverse effects. |
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| Elvitegravir Imipramine 166 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of imipramine | Potential for increased risk of imipramine adverse effects |
If coadministering initiate imipramine at lowest dose. Monitor response and titrate according to efficacy and adverse effects. |
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| Elvitegravir Iloperidone 165 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of iloperidone | Potential for increased risk of iloperidone adverse effects |
Decrease iloperidone dose by 50% |
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| Elvitegravir Edoxaban 164 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of edoxaban | Potential for increased risk of bleeding |
Edoxaban 30 mg once daily if using for DVT / PE. No adjustment needed for stroke prevention in persons with atrial fibrillation. |
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| Elvitegravir Doxepin 163 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of doxepin | Potential for increased risk of doxepin adverse effects (e.g. sedation) |
If coadministering initiate doxepin at lowest dose. Monitor response and titrate according to efficacy and adverse effects. |
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| Elvitegravir Doxazosin 162 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of doxazosin | Potential for increased risk of doxazosin adverse effects |
Initiate low dose doxazosin and titrate dose according to efficacy and adverse effects. |
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| Elvitegravir Daclatasvir 161 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of daclatasvir | Decrease daclatasvir dose to 30 mg daily |
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| Elvitegravir Colchicine 160 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of colchicine | Potential for increased risk of colchicine adverse effects |
If coadministering for treatment of gout flares use 0.6 mg single dose followed by 0.3 mg single dose 1h later and do not repeat for at least 3 days. If coadministering for prophylaxis of gout flares adjust based on original regimen (e.g. reduce 0.6 mg BID to 0.3 mg once daily, reduce 0.6 mg once daily to 0.3 mg every other day). If coadministering for FMF, maximum daily dose is 0.6 mg. Do not coadminister in hepatic or renal impairment. |
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| Elvitegravir Clarithromycin 159 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of clarithromycin | No dose adjustment necessary if patients CrCl > 60 mL / min. Reduce clarithromycin dose by 50% if CrCl is between 50-60 mL / min. Do not coadminster if CrCl > 50 mL / min. |
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| Elvitegravir Cariprazine 158 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of cariprazine | Potential for increased risk of cariprazine adverse effects |
If patient is receiving EVG / c, 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 can be increased to a maximum dose of 3 mg daily. If EVG / c is withdrawn, cariprazine dose may need to be increased. If patient is receiving cariprazine 3 mg or 6 mg daily, reduce cariprazine dose by half. For patients taking cariprazine 4.5 mg daily, the dose should be reduced to 1.5 mg or 3 mg daily. For patients taking cariprazine 1.5 mg daily, change to 1.5 mg every other day. If EVG / c is withdrawn, cariprazine dose may need to be increased. |
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| Elvitegravir Calcifediol 157 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of calcifediol | Monitor serum 25-hydroxyvitamin D, intact PTH, and serum Ca concentrations. Adjust dose as needed. |
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| Elvitegravir Buspirone 156 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of buspirone | Potential for increased risk of buspirone adverse effects |
If coadministering start with low dose buspirone and titrate accordingly. A dose reduction may be required. Monitor for side effects. |
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| Elvitegravir Bupropion 155 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of bupropion | Potential for increased risk of bupropion adverse effects |
If coadministering initiate bupropion at lowest dose. Monitor response and titrate according to efficacy and adverse effects. |
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| Elvitegravir Bosentan 154 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of bosentan | Potential for increased risk of bosentan adverse effects |
If patient has been on elvitegravir / cobicistat for more than 10 days, start with bosentan dose of 62.5 mg daily or every other day. If patient is currently on bosentan and requires use of elvitegravir / cobicistat, 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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| Elvitegravir Beclomethasone 153 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of Beclomethasone | Potential for increased risk of corticosteroid adverse effects |
If coadministering, initiate lower dose and monitor for corticosteroid adverse effects |
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| Elvitegravir Brexpiprazole 152 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of aripiprazole | Potential for increased risk of brexpiprazole adverse effects |
Administer 25% of usual bexpiprazole dose and titrate based on efficacy and adverse effects |
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| Elvitegravir Aripiprazole 151 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of aripiprazole | Potential for increased risk of aripiprazole adverse effects |
Not reported |
Administer 25% of usual aripiprazole dose and titrate based on efficacy and adverse effects |
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| Elvitegravir Amitriptyline 150 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of amitriptyline | Potential for increased risk of amitriptyline adverse effects |
If coadministering initiate amitriptyline at lowest dose. Monitor response and titrate according to efficacy and adverse effects. |
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| Elvitegravir Sucralfate 149 | Yellow: Adjust dosing | Adjust dosing to avoid decreased elvitegravir efficacy | Potential decrease in antiretroviral efficacy |
Separate elvitegravir / cobicistat from sucralfate by at least 2 hours. |
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| Elvitegravir Iron 148 | Yellow: Adjust dosing | Adjust dosing to avoid decreased elvitegravir efficacy | Potential decrease in antiretroviral efficacy |
Separate elvitegravir / cobicistat from medications containing polyvalent cations by at least 2 hours. |
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| Elvitegravir Calcium carbonate 147 | Yellow: Adjust dosing | Adjust dosing to avoid decreased elvitegravir efficacy | Potential decrease in antiretroviral efficacy |
Separate elvitegravir / cobicistat from medications containing polyvalent cations by at least 2 hours. |
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| Elvitegravir Calcium carbonate 146 | Yellow: Adjust dosing | Adjust dosing to avoid decreased elvitegravir efficacy | Potential decrease in antiretroviral efficacy |
Separate elvitegravir / cobicistat from medications containing polyvalent cations by at least 2 hours. |
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| Elvitegravir Saxagliptin 145 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of saxagliptin | Potential for increased saxagliptin adverse effects |
Limit saxagliptin dose to 2.5 mg once daily |
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| Elvitegravir Pitavastatin 144 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of pitavastatin | Potential for increased risk of pitavastatin adverse effects |
Initiate pitavastatin at lowest dose and titrate carefully. Monitor for adverse effects. |
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| Elvitegravir Aluminum and magnesium hydroxide antacid 143 | Yellow: Adjust dosing | Adjust dosing to avoid decreased elvitegravir efficacy | Potential decrease in antiretroviral efficacy |
AUC decreased 40-50% when administered simultaneously with antacid; AUC decreased 15-20% when administered 2 hours before or after antacid. No change in AUC if separated by 4-hour interval. |
Not reported | Not reported |
Administer elvitegravir at least 2 hours before or at least 6 hours after supplements that contain polyvalent cations. |
| Elvitegravir Rosuvastatin 128 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of rosuvastatin | Potential for increased risk of rosuvastatin adverse effects (e.g. myopathy) |
No significant change |
10 mg single dose | Cmax increased 89%, AUC increased 38%, Cmin increased 43% |
Initiate rosuvastatin at lowest dose and titrate carefully. Monitor for adverse effects. |
| Elvitegravir Atorvastatin 127 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of atorvastain | Potential for increased atorvastatin adverse effects (e.g. myopathy) |
AUC decreased 8% |
10 mg single dose | Cmax increased 132%; AUC increased 160%. |
Initiate with lowest Potential dose of atorvastatin. Titrate carefully while monitoring for adverse effects. Do not exceed 20 mg of atorvastatin daily. |
| Elvitegravir Desipramine 125 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of desipramine | Increased desipramine effects |
Not reported |
50 mg single dose | Cmax increased 24%, AUC increased 65% |
If coadministering, initiate low dose desipramine and titrate according to efficacy and adverse effects. |
| Dolutegravir Iron 96 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy if given with iron. |
Cmax decreased 57%, AUC decreased 54%, Cmin decreased 56% when administered simultaneously with ferrous fumarate, fasting conditions. No significant change in dolutegravir Cmax or AUC if given simultaneously with ferrous fumarate, with food or if given 2 hours after ferrous fumarate. |
324 mg | Not studied |
Administer dolutegravir 2 hours before or 6 hours after taking medications containing polyvalent cations. Alternatively, administer dolutegravir simulatenously with iron supplements and with food. |
| Dolutegravir Multivitamin 95 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 35%, AUC decreased 33%, Cmin decreased 32% |
One-A-Day given simultaneously with dolutegravir | Not studied |
Administer dolutegravir 2 hours before or 6 hours after taking medications containing polyvalent cations. |
| Dolutegravir Sucralfate 94 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Not studied (may decreased dolutegravir levels) |
Not studied |
Administer dolutegravir 2 hours before or 6 hours after sucralfate |
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| Dolutegravir Calcium carbonate 93 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy if taken without food |
Cmax decreased 37%, AUC decreased 39%, Cmin decreased 39% if taken together, fasting conditions. No significant change in dolutegravir AUC if taken 2 hours before calcium carbonate or if taken simultaneously with food. |
1200 mg | Not studied |
Administer dolutegravir 2 hours before or 6 hours after calcium-containing supplements. Alternatively, administer dolutegravir simulatenously with calcium supplements and with food. |
| Dolutegravir Calcium carbonate 92 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy if taken without food |
Cmax decreased 37%, AUC decreased 39%, Cmin decreased 39% if taken together, fasting conditions. No significant change in dolutegravir AUC if taken 2 hours before calcium carbonate or if taken simultaneously with food. |
1200 mg | Not studied |
Administer dolutegravir 2 hours before or 6 hours after calcium-containing supplements. Alternatively, administer dolutegravir simulatenously with calcium supplements and with food. |
| Dolutegravir Calcium carbonate 91 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy if taken without food |
Cmax decreased 37%, AUC decreased 39%, Cmin decreased 39% if taken together, fasting conditions. No significant change in dolutegravir AUC if taken 2 hours before calcium carbonate or if taken simultaneously with food. |
1200 mg | Not studied |
Administer dolutegravir 2 hours before or 6 hours after calcium-containing supplements. Alternatively, administer dolutegravir simulatenously with calcium supplements and with food. |
| Dolutegravir Aluminum and magnesium hydroxide antacid 90 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 18%, AUC decreased 26%, Cmin decreased 30% |
Maalox given 2 hours after dolutegravir | Not studied |
Administer dolutegravir 2 hours before or 6 hours after antacids. |
| Dolutegravir EFV 89 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 39%, AUC decreased 57%, Cmin decreased 75% |
600 mg once daily | Not studied |
Adjust dose of dolutegravir to 50 mg twice daily for treatment-naive and treatment experienced, INSTI naive adult patients, in pediatrics, increased the weight-based dose to twice daily, Use alternate combinations in INSTI experienced or INSTI resistance patients |
| Dolutegravir RIF 88 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax increased 18%, AUC increased 33%, Cmin increased 22% (when compared to dolutegravir 50 mg once daily) |
600 mg daily | Not studied |
Adjust dose of dolutegravir to 50 mg twice daily for treatment-na•ve and treatment experienced, INSTI na•ve adult patients, in pediatrics, increased the weight-based dose to twice daily, Use alternate combinations in INSTI experienced or INSTI resistance patients |
| Dolutegravir RIF 87 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of dolutegravir | Potential decrease in antiretroviral efficacy |
Cmax decreased 43%, AUC decreased 54%, Cmin decreased 72% (when compared to dolutegravir 50 mg BID without rifampin) |
600 mg daily | Not studied |
Adjust dose of dolutegravir to 50 mg twice daily for treatment-na•ve and treatment experienced, INSTI na•ve adult patients, in pediatrics, increased the weight-based dose to twice daily, Use alternate combinations in INSTI experienced or INSTI resistance patients |
| Dolutegravir Metformin 86 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of metformin | Potential increased adverse effects from metformin (e.g. GI side effects). |
Not studied |
500 mg BID | Cmax increased 66%, AUC increased 79%, Cmin increased 9% when given with dolutegravir once daily. If given with dolutegravir 50 mg BID, then metformin Cmax increased 111%, AUC increased 145%, and Cmin increased 14% |
Limit metformin dose to 1,000 mg per day. When starting / stopping DTG in patient on metformin, dose adjustment of metformin may be necessary to maintain optimal glycemic control and / or minimize GI symptoms. |
| Bictegravir Iron 65 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of bictegravir | Potential decrease in antiretroviral efficacy |
If administered simultaneously in the fasted state Cmax decreased 71%, AUC decreased 63%. If administered simultaneously in the fed state Cmax decreased 25%, AUC decreased 16% |
324 mg single dose | Not reported |
Bictegravir should be administered simultaenously with iron supplements, with food. Monitor for virologic efficacy. |
| Bictegravir Calcium carbonate 64 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of bictegravir | Potential decrease in antiretroviral efficacy |
If administered simultaneously in the fasted state Cmax decreased 42%, AUC decreased 33%. If administered simultaneously in the fed state Cmax decreased 10%, AUC increased 3% |
1200 mg single dose | Not reported |
Bictegravir should be administered simultaenously with calcium carbonate supplements, with food. |
| Bictegravir Calcium carbonate 63 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of bictegravir | Potential decrease in antiretroviral efficacy |
If administered simultaneously in the fasted state Cmax decreased 42%, AUC decreased 33%. If administered simultaneously in the fed state Cmax decreased 10%, AUC increased 3% |
1200 mg single dose | Not reported |
Bictegravir should be administered simultaenously with calcium carbonate supplements, with food. |
| Maraviroc Voriconazole 54 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
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| Maraviroc Voriconazole 53 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
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| Maraviroc Posaconazole 52 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
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| Maraviroc Itraconazole 51 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
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| Maraviroc Clarithromycin 50 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
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| Maraviroc DRV 49 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Maraviroc Cmin increased 16%; Cmax no significant change (when compared to maraviroc 300 mg BID without darunavir / ritonavir in separate control arm) |
800 / 100 mg BID | Not reported |
Reduce dose of maraviroc to 150 mg BID |
|
| Maraviroc DRV/c 48 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Reduce dose of maraviroc to 150 mg BID |
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| Maraviroc RTV 47 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Maraviroc AUC increased 161%; Cmax increased 28% |
100 mg BID | Not reported |
Reduce dose of maraviroc to 150 mg BID |
| Maraviroc DRV/r 46 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Maraviroc AUC increased 305%; Cmax increased 129% |
600 mg / 100 mg BID | Not reported |
Reduce dose of maraviroc to 150 mg BID |
| Maraviroc ATV/r 45 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Maraviroc AUC increased 388%; Cmax increased 167% |
300 mg / 100 mg daily | Not reported |
Reduce dose of maraviroc to 150 mg BID |
| Maraviroc ATV 44 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Maraviroc AUC increased 257%; Cmax increased 109% |
400 mg daily | Not reported |
Reduce dose of maraviroc to 150 mg BID |
| Maraviroc Elvitegravir / Cobicistat / Emtricitabine / Tenofovir alafenamide 43 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce dose of maraviroc to 150 mg BID |
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| Maraviroc ATV/c 42 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce dose of maraviroc to 150 mg BID |
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| Maraviroc Ketoconazole 41 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Increased maraviroc effects |
Maraviroc AUC increased 400%; Cmax increased 238%; Cmin increased 275% |
400 mg daily | Not reported |
Reduce dose of maraviroc to 150 mg BID |
| Maraviroc Phenytoin 40 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of maraviroc | Potential decrease in antiretroviral efficacy |
Increase maraviroc dose to 600 mg BID. If including MVC, ETR plus a strong CYP3A4 inhibitor in the regimen, reduce maraviroc dose to 150 mg BID |
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| Maraviroc Phenobarbital 39 | Yellow: Adjust dosing | Adjust dosing to avoid decreased levels of maraviroc | Potential decrease in antiretroviral efficacy |
Increase maraviroc dose to 600 mg BID. If including MVC, ETR plus a strong CYP3A4 inhibitor in the regimen, reduce maraviroc dose to 150 mg BID |
