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Updates to the Database of ARV Drug Interactions
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The following table summarizes recent additions to the HIV InSite Database of Antiretroviral Drug Interactions.For a full description of the updates, including references to the studies from which the data were derived, go to the database, click on a specific drug name, and search for the interacting agent.

Note: Numerous interactions between elvitegravir/cobicistat and other medications used for treatment of HIV infection have been identified. These interactions are compiled as a separate table at the bottom of this page.

New ARV Interactions (May-October 2012)
Drug OneDrug TwoClinical EffectsMechanismsManagement
Source: McNicholl I. HIV InSite Database of Antiretroviral Drug Interactions. University of California San Francisco: Center for HIV Information; 2012.
AtazanavirPitavastatinPossibly increased pitavastatin effectsStart at lowest dosage and titrate to effect
DarunavirArtemetherDosage adjustment not established
DarunavirLumefantrineDosage adjustment not established
DarunavirMilk thistleNo dosage adjustment necessary
DarunavirPitavastatinTitrate pitavastatin to effect
EfavirenzEthinyl estradiol/norethindrone acetateNo dosage adjustment necessary
EtravirineArtemetherDecreased antimalarial effectsUse with caution; avoid if possible
EtravirineLumefantrineDecreased antimalarial effectsUse with caution; avoid if possible
EtravirineBoceprevirDecreased etravirine effectsDosage adjustment not established; use with caution
Lopinavir/ritonavirGingko bilobaNo dosage adjustment necessary
RaltegravirGingko bilobaPotential increase in raltegravir bioavailabilityNo dosage adjustment necessary

Drug Interactions with Elvitegravir/Cobicistat
Coadministered DrugDosageClinical EffectsMechanismsManagement
Source: McNicholl I. HIV InSite Database of Antiretroviral Drug Interactions. University of California San Francisco: Center for HIV Information; 2012.
AlfuzosinPotentially increased alfuzosin effects (eg, hypotension)Do not coadminister
Antacids (Maalox, Mylanta, Riopan, Milk of Magnesia, Others)

  • 20 mL given 2 hours after elvitegravir/50 mg elvitegravir with 100 mg ritonavir single dose
  • 20 mL single dose 4 hours before elvitegravir/150 mg elvitegravir with 100 mg ritonavir single dose
  • 20 mL single dose given 2 hours before elvitegravir /50 mg elvitegravir with 100 mg ritonavir single dose
  • 20 mL single dose given 4 hours after elvitegravir/50 mg elvitegravir with 100 mg ritonavir single dose

  • Separate elvitegravir from antacids by at least 2 hours


  • No dosage adjustment necessary


  • No dosage adjustment necessary


  • No dosage adjustment necessary
BoceprevirDo not coadminister
CisapridePotentially increased cisapride effects (eg, cardiac arrhythmias)Do not coadminister
ClarithromycinAvoid combination if possible; Consider alternative agents

Alternative Agents:
Azithromycin
Desipramine50 mg/150 mg cobicistatIncreased desipramine effectsUse with caution
Digoxin0.5 mg/150 mg cobicistatNo dosage adjustment necessary; use with caution and monitor concentrations
ErgotaminePotentially increased ergot effects (eg, ergot toxicity, peripheral vasospasm, ischemia)Do not coadminister
Ethinyl estradiol/norgestimate 0.18/0.215/0.250 mcg norgestimate/150 mg elvitegravir/150 mg cobicistatIncreased norgestimate effects; decreased ethinyl estradiol effectsUse with caution; alternative form of contraception recommended
Famotidine

  • 40 mg given 12 hours after elvitegravir/150 mg elvitegravir/150 mg cobicistat
  • 40 mg given simultaneously with elvitegravir/150 mg elvitegravir/150 mg cobicistat

  • No dosage adjustment necessary


  • No dosage adjustment necessary
ItraconazoleAvoid itraconazole >200 mg daily and monitor itraconazole concentrations with coadministration
Ketoconazole200 mg BID/150 mg elvitegravir with 100 mg ritonavirIncreased elvitegravir and ketoconazole effectsAvoid if possible, avoid ketoconazole >200 mg daily
LovastatinPotentially increased lovastatin effects (eg, myopathy, rhabdomyolysis)Do not coadminister
MetoprololIncreased metoprolol effectsUse with caution; titrate to effect
MidazolamPotentially increased midazolam effects (eg, prolonged sedation, altered mental status, respiratory depression)Do not coadminister
Omeprazole

  • 20 mg given 12 hours after elvitegravir/150 mg elvitegravir/150 mg cobicistat
  • 20 mg given 2 hours before elvitegravir/150 mg elvitegravir/150 mg cobicistat
  • 40 mg given 2 hours before elvitegravir/50 mg elvitegravir with 100 mg ritonavir

  • No dosage adjustment necessary


  • No dosage adjustment necessary


  • No dosage adjustment necessary
PimozidePotentially increased pimozide effects (eg, cardiac arrhythmias)Do not coadminister
PosaconazoleMonitor posaconazole concentrations with coadministration
Rifabutin150 mg every other day/150 mg elvitegravir/150 mg cobicistatIncreased rifabutin effectsDo not coadminister; consider alternative antiretrovirals
RifampinDecreased elvitegravir and cobicistat effectsInduction of CYP450 by rifampinDo not coadminister; consider alternative antivirals
Rosuvastatin10 mg/150 mg elvitegravir/150 mg cobicistatIncreased rosuvastatin effectsAvoid coadministration if possible
SildenafilPotentially increased sildenafil effects when used for pulmonary hypertensionDo not coadminister
SimvastatinPotentially increased simvastatin effects (eg, myopathy, rhabdomyolysis)Do not coadminister
St. John's WortPotentially decreased elvitegravir and cobicistat effectsDo not coadminister
TelaprevirDo not coadminister
TriazolamPotentially increased triazolam effects (eg, prolonged sedation, altered mental status, respiratory depression)
VoriconazoleMonitor voriconazole concentrations with coadministration

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