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Database of Antiretroviral Drug Interactions

Interactions between Antibiotics (including antimycobacterials) and Antiretrovirals

Interactions with Azithromycin
Antiretroviral (ARV)Dose of ARVDose of AzithromycinEffect on ARV LevelsEffect on Azithromycin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Efavirenz90
(EFV)(Sustiva)
400 mg x 7 days600 mg x 1 doseNo significant changeAzithromycin AUC: no significant change; Cmax: increased 22%- -

No dose adjustment necessary

Indinavir330
(IDV)(Crixivan)
800 mg TID1200 mg x 1 doseNo significant change- - -

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Ciprofloxacin
Antiretroviral (ARV)Dose of ARVDose of CiprofloxacinEffect on ARV LevelsEffect on Ciprofloxacin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Didanosine326, 84, 19
(ddI)(Videx)
200 mg (buffered formulation) Q12H x 3 days750 mg Q12H x 3 daysDidanosine AUC: decreased 16%; Cmax: decreased 28%Ciprofloxacin AUC: decreased 26% when ciprofloxacin is dosed 2 hours before or 6 hours after didanosine tablets. Ciprofloxacin AUC: decreased 15-fold (with simultaneous didanosine dosing)Decreased ciprofloxacin effectsChelation and adsorption of ciprofloxacin by divalent/trivalent cations contained in didanosine buffer

Consider didanosine EC or administer didanosine tablets/suspension 6 hours prior to or 2 hours after ciprofloxacin administration

Didanosine84
(ddI)(Videx)
400 mg (enteric coated capsule) x 1 dose750 mg x 1 doseNot studiedNo significant change--

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Clarithromycin
Antiretroviral (ARV)Dose of ARVDose of ClarithromycinEffect on ARV LevelsEffect on Clarithromycin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir361, 60
(APV)(Agenerase)
1200 mg BID x 7 doses500 mg BID x 7 dosesAmprenavir Cmax: increased 15%; AUC: increased 18%; Cmin: increased 39%Clarithromycin Cmax: no significant change; AUC: no significant change;14-hydroxy clarithromycin Cmax: decreased 32%; AUC: decreased 35%-Inhibition of CYP450 3A4 by amprenavir

No dose adjustment necessary

Atazanavir363
(ATV)(Reyataz)
400 mg QD on days 1-10500 mg BID on days 7-11 and 18-21Atazanavir AUC: increased 28%; Cmax: no significant change; Cmin: increased 91%Clarithromycin AUC: increased 94%; Cmax: increased 50%; Cmin: decreased 62%; 14-hydroxyclarithromycin AUC: decreased 70%; Cmax: decreased 72%; Cmin: increased 164%Increased clarithromycin effects. May cause QTc prolongation.Inhibition of CYP450 3A4 by atazanavir

Reduce clarithromycin dose by 50%

Alternative Agents:
azithromycin

Atazanavir/cobicistat755
(others)(Evotaz)
--Not studied; Potentially increased effects Not studied; Potentially increased effects--

Avoid combination if possible; consider alternative antibiotics

Alternative Agents:
azithromycin

Darunavir161
(DRV)(Prezista)
400 mg BID with ritonavir 100 mg BID500 mg BIDDarunavir Cmax: decreased 17%Clarithromycin AUC: increased 57%--

Monitor for clarithromycin-related toxicities or consider alternative macrolide. Reduce clarithromycin dose by 50% in patients with CrCl 30– 60 mL/min.Reduce clarithromycin dose by 75% in patients with CrCl <30 mL/min.

Alternative Agents:
Azithromycin

Delavirdine88
(DLV)(Rescriptor)
300 mg TID500 mg BIDDelavirdine AUC: increased 44%Clarithromycin AUC: increased 100%;14-hydroxy clarithromycin AUC: decreased 75%Not studiedInhibition of CYP450 3A4 and 2C9 by delavirdine

-

Antiretroviral (ARV)Dose of ARVDose of ClarithromycinEffect on ARV LevelsEffect on Clarithromycin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Efavirenz90
(EFV)(Sustiva)
400 mg x 7 days500 mg Q12H x 7 daysNo significant changeClarithromycin AUC: decreased 39%; Cmax: decreased 26%;14-hydroxy clarithromycin AUC: increased 34%; Cmax: increased 49%-Induction of CYP450 3A4 by efavirenz

Dose adjustment not established

Elvitegravir/cobicistat639, 623
(Genvoya, Stribild)
--Not studied; Potentially increased effectsNot studied; Potentially increased effects--

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.

Alternative Agents:
Azithromycin

Etravirine405
(ETR)(Intelence)
-500 mg BIDEtravirine AUC: increased 42%; Cmax: increased 46%; Cmin: increased 46%Clarithromycin AUC: decreased 37%; Cmax: decreased 34%; Cmin: decreased 53%; 14-hydroxyclarithromycin AUC: increased 21%; Cmax: increased 33%Increased etravirine effects; decreased clarithromycin effectsInduction of CYP450 3A4 by etravirine; inhibition by clarithromycin

Avoid combination if possible; consider use of azithromycin

Alternative Agents:
Azithromycin

Indinavir16, 254
(IDV)(Crixivan)
800 mg Q8H x 1 week500 mg Q12H x 1 weekIndinavir AUC: increased 29%Clarithromycin AUC: increased 53%-Inhibition of CYP450 3A4 by both drugs

No dose adjustment necessary

Indinavir359
(IDV)(Crixivan)
800 mg Q8H x 1 week500 mg Q12H x 1 weekIndinavir AUC: increased 19%; Cmax: no significant change; Cmin: increased 52%Clarithromycin AUC: increased 47%; Cmax: increased 20%; 14-hydroxyclarithromycin AUC: decreased 49%; Cmax: decreased 49%Increased indinavir effectsInhibition of CYP450 3A4 by both drugs

No dose adjustment necessary

Lopinavir/ritonavir727, 78
(LPV/r)(Kaletra)
---May increase clarithromycin levelsIncreased clarithromycin effectsInhibition of CYP450 3A4 by lopinavir/ritonavir

No dose adjustment necessary. Monitor for clarithromycin-related toxicities or consider alternative macrolide. Reduce clarithromycin dose by 50% in patients with CrCl 30– 60 mL/min. Reduce clarithromycin dose by 75% in patients with CrCl <30 mL/min.

Alternative Agents:
Azithromycin

Antiretroviral (ARV)Dose of ARVDose of ClarithromycinEffect on ARV LevelsEffect on Clarithromycin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Nevirapine362, 95
(NVP)(Viramune)
200 mg QD x 2 weeks then 200 BID500 mg BIDNevirapine Cmin: no significant changeClarithromycin AUC: decreased 29%; Cmax: decreased 20%; Cmin: decreased 46%; 14-hydroxy clarithromycin AUC: increased 27%--

No dose adjustment necessary

Ritonavir360, 56
(RTV)(Norvir)
200 mg TID500 mg BIDAUC: no significant change; Cmax: increased 15%Clarithromycin AUC: increased 77%; Cmax: increased 31%; Cmin: increased 182%Increased clarithromycin effectsInhibition of CYP450 3A4 by ritonavir

No dose adjustment necessary

Saquinavir44, 75
(SQV)(Fortovase, Invirase)
1200 mg TID x 7 days500 mg BID x 7 daysSaquinavir soft gel caps AUC: increased 177%; Cmax: increased 187%; saquinavir hard gel caps AUC: increased 500%Clarithromycin AUC: increased 45%; Cmax: increased 39%; 14-hydrooxyclarithromycin AUC: decreased 24%; Cmax: decreased 34%- Inhibition of CYP450 3A4 by clarithromycin

Dose adjustment not established

Stavudine275
(d4T)(Zerit)
40 mg BID500 mg BIDStavudine AUC: no significant change; Cmax: decreased 15%; Cmin: decreased 41%---

No dose adjustment necessary

Tipranavir154
(TPV)(Aptivus)
500 mg BID with 200 mg ritonavir BID500 mg BID x 25 dosesTipranavir AUC: increased 66%; Cmax: increased 40%; Cmin: increased 100%Clarithromycin AUC: increased 19%; Cmax: no significant change; Cmin: increased 68%14-hydroxyclarithromycin AUC: decreased 97%; Cmax: decreased 97%; Cmin: decreased 95%Increased tipranavir effects; possible decreased clarithromycin effectsInhibition of CYP450 3A4 by clarithromycin; induction of CYP450 3A4 by tipranavir

No dose adjustment necessary

Zidovudine358, 81
(AZT, ZDV)(Retrovir)
-500 mg BIDZidovudine Cmax: increased 50%; AUC: no significant change---

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Co-trimoxazole
Antiretroviral (ARV)Dose of ARVDose of Co-trimoxazoleEffect on ARV LevelsEffect on Co-trimoxazole LevelsPotential Clinical EffectsMechanism of InteractionManagement
Delavirdine88
(DLV)(Rescriptor)
- - No significant change- - -

No dose adjustment necessary

Indinavir331, 16
(IDV)(Crixivan)
400 mg Q6H x 1 week160 mg/800 mg Q12H x 1 weekNo significant changeTrimethoprim AUC: increased 19%; sulfamethoxazole AUC: no significant change- -

No dose adjustment necessary

Lamivudine332, 333
(3TC)(Epivir)
300 mg QD x 1dose160 mg/800 mg QD x 5 daysLamivudine AUC: increased 44%Not studiedIncreased lamivudine effects-

No dose adjustment necessary

Ritonavir55
(RTV)(Norvir)
500 mg Q12H x 12 days160 mg/800 mg x 1 dose- Sulfamethoxazole AUC: decreased 20%; trimethoprim AUC: increased 20%- Induction of CYP450 3A4 by ritonavir

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Dapsone
Antiretroviral (ARV)Dose of ARVDose of DapsoneEffect on ARV LevelsEffect on Dapsone LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir60
(APV)(Agenerase)
--Not studied; may increase amprenavir levels---

No dose adjustment necessary

Delavirdine88
(DLV)(Rescriptor)
---Not studied; may increase dapsone levelsIncreased dapsone effects-

No dose adjustment necessary

Didanosine327, 84
(ddI)(Videx)
200 mg (buffered formulation) Q12H x 14 days100 mg x 1 doseNo significant changeNo significant change- -

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Erythromycin
Antiretroviral (ARV)Dose of ARVDose of ErythromycinEffect on ARV LevelsEffect on Erythromycin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir60
(APV)(Agenerase)
--Not studied; may increase amprenavir levelsNot studied; may increase erythromycin levels-Inhibition of CYP450 3A4 by either drug

Dose adjustment not established

Alternative Agents:
Azithromycin Clarithromycin

Atazanavir/cobicistat755
(others)(Evotaz)
-- Not studied; Potentially increased effects Not studied; Potentially increased effects --

Avoid combination if possible; consider alternative antibiotics

Alternative Agents:
azithromycin

Saquinavir282
(SQV)(Fortovase, Invirase)
1200 mg TID250 mg QID x 7 daysSaquinavir AUC: increased 99%; Cmax: increased 106% when studied in HIV-infected patients-Increased saquinavir effectsInhibition of CYP450 3A4 by erythromycin

Dose adjustment not established

"-" indicates that there are no data available
Interactions with Isoniazid
Antiretroviral (ARV)Dose of ARVDose of IsoniazidEffect on ARV LevelsEffect on Isoniazid LevelsPotential Clinical EffectsMechanism of InteractionManagement
Dolutegravir753
(Tivicay)
50 mg once daily15 mg/kg + rifapentine 900 mg once weeklyDTG AUC decreased 46%; Cmin decreased 74%INH AUC increased 67-92% in 2/4 subjects. Rifapentine no significant change.Potential adverse effects of isoniazid (flu-like symptoms, nausea, vomiting, and fever)-

Do not coadminister

Indinavir16
(IDV)(Crixivan)
800 mg Q8H x 1 week300 mg QD x 1 weekNo significant changeNo significant change--

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Metronidazole
Antiretroviral (ARV)Dose of ARVDose of MetronidazoleEffect on ARV LevelsEffect on Metronidazole LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir211
(APV)(Agenerase)
Oral solution (contains propylene glycol)- - - Propylene glycol toxicity (eg, acidosis, CNS depression)Inhibition of alcohol and aldehyde dehydrogenase by metronidazole

Do not coadminister with amprenavir oral solution

Alternative Agents:
Amprenavir capsules

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
Oral solution (contains alcohol)- - - Disulfiram reaction (hypotension, headache, nausea, vomiting)Inhibition of alcohol and aldehyde dehydrogenase by metronidazole

Do not coadminister; may consider lopinavir/ritonavir capsules

Ritonavir55
(RTV)(Norvir)
Oral solution (contains alcohol) and capsules---Disulfiram-like reaction (eg, headache, hypotension, flushing, vomiting)Inhibition of alcohol and aldehyde dehydrogenase by metronidazole

Do not coadminister

"-" indicates that there are no data available
Interactions with Quinupristin/Dalfopristin
Antiretroviral (ARV)Dose of ARVDose of Quinupristin/DalfopristinEffect on ARV LevelsEffect on Quinupristin/Dalfopristin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Indinavir334
(IDV)(Crixivan)
- - May increase indinavir levels- Increased indinavir effectsInhibition of CYP450 3A4 by quinupristin/ dalfopristin

Dose adjustment not established

"-" indicates that there are no data available
Interactions with Rifabutin
Antiretroviral (ARV)Dose of ARVDose of RifabutinEffect on ARV LevelsEffect on Rifabutin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir340
(APV)(Agenerase)
1200 mg BID300 mg QD x 14 daysNo significant changeRifabutin AUC: increased 193%; Cmax: increased 119%; 25-O-desacetylrifabutin AUC: increased 1230%; clearance: decreased 66%Increased rifabutin effects (eg, uveitis)Inhibition of CYP450 3A4 by amprenavir

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Amprenavir60, 62, 63
(APV)(Agenerase)
1200 mg BID x 10 days300 mg QD x 10 daysAmprenavir AUC: decreased 15%; Cmax: no significant change; Cmin: decreased 15%Rifabutin AUC: increased 193%; Cmax: increased 119%; Cmin: increased 271%Increased rifabutin effects (eg, uveitis)Inhibition of CYP450 3A4 by amprenavir

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Atazanavir341
(ATV)(Reyataz)
400 mg QD on days 1-14, 400 mg QD with ritonavir 100 mg QD on days 15-28150 mg QD on days 15-28Atazanavir AUC: increased 191%; Cmax: increased 81%Not studiedIncreased atazanavir effects-

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Atazanavir341
(ATV)(Reyataz)
400 mg QD on days 1-28150 mg QD on days 15-28Atazanavir Cmax: increased 34%Not studied--

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Atazanavir
(ATV)(Reyataz)
600 mg QD on days 11-20300 mg QD on days 1-10, then 150 mg QD on days 11-20Not studiedRifabutin AUC: increased 110%; Cmax: increased 118%; Cmin: increased 243%; 25-O-desacetylrifabutin AUC: increased 2101%; Cmax: increased 720%; Cmin: increased 7460%Increased rifabutin effects (eg, uveitis)Inhibition of CYP450 3A4 by atazanavir

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Antiretroviral (ARV)Dose of ARVDose of RifabutinEffect on ARV LevelsEffect on Rifabutin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Atazanavir/cobicistat755, 727
(others)(Evotaz)
---Not studied; may increase rifabutin levels--

Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring.

Bictegravir759
(Biktarvy)
75 mg daily300 mg daily (fasted)Cmax decreased 20%; AUC decreased 38%; Cmin decreased 56%Not studiedPotentially loss of antiviral efficacy-

Use alternative agents

Darunavir417
(DRV)(Prezista)
600 mg Q12H150 mg QODDarunavir AUC: increased 57%; Cmin: increased 75%; Cmax: increased 42% Ritonavir AUC: increased 66%; Cmin: increased 31%; Cmax: increased 68%Rifabutin AUC: no significant change; Cmin: increased 64%; Cmax: decreased 28% 25-O-desacetylrifabutin AUC: increased 881%; Cmin: increased 2610%; Cmax: increased 377%Increased darunavir and rifabutin effects. Note thatlLower rifabutin exposure has been reported in HIV- infected patients as compared to healthy study participants.Inhibition of CYP450 3A4 by darunavir

Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring.

Darunavir/cobicistat727
(Prezcobix)
--- Not studied; may increase rifabutin levels--

Use rifabutin 150 mg once daily or 300 mg three times a week. Monitor for antimycobacterial activity and consider therapeutic drug monitoring.

Delavirdine88
(DLV)(Rescriptor)
400 mg TID300 mg QDDelavirdine AUC: decreased 80%Rifabutin AUC: increased 100%Decreased delavirdine effects; increased rifabutin effects (eg, uveitis)Induction of CYP450 3A4 by rifabutin; inhibition of CYP450 3A4 by delavirdine

Do not coadminister

Didanosine84
(ddI)(Videx)
167 mg or 250 mg (buffered formulation) Q12H x 12 days300 mg or 600 mg QD x 12 daysDidanosine AUC: no significant change; Cmax: increased 17%Not studied--

No dose adjustment necessary

Antiretroviral (ARV)Dose of ARVDose of RifabutinEffect on ARV LevelsEffect on Rifabutin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Dolutegravir641
(Tivicay)
50 mg QD300 mg QDDolutegravir Cmin: decreased 30% ---

No dose adjustment necessary

Efavirenz338
(EFV)(Sustiva)
600 mg QD600 mg twice weeklyNot studiedRifabutin AUC: no significant change; Cmax: no significant change (when compared to rifabutin 300 mg twice weekly without efavirenz)--

No dose adjustment necessary

Efavirenz
(EFV)(Sustiva)
600 mg QD300 mg or 450 mg twice weeklyNot studiedOn 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)Possibly decreased rifabutin effectsInduction of CYP450 3A4 by efavirenz

Increase rifabutin to 450-600 mg QD

Efavirenz90, 345
(EFV)(Sustiva)
600 mg x 14 days300 mg QD x 14 daysNo significant changeRifabutin AUC: decreased 38%; Cmax: decreased 32%Decreased rifabutin effectsInduction of CYP450 3A4 by efavirenz

Increase rifabutin to 450-600 mg QD

Elvitegravir697
(Vitekta)
300 mg plus 100 mg ritonavir150 mg every other dayNo effectIncreased rifabutin levels and increased rifabutin metabolite (25-O-desacetylrifabutin). Potential increase of 25-O-desacetylrifabutin AUC of 951% if given with elvitegravir with a ritonavir-boosted protease inhibitorPotential for increased rifabutin toxicityInhibition of CYP3A4

Use rifabutin 150mg once daily or 300 mg three times weekly if co-administering with elvitegravir and a ritonavir-boosted PI. Monitor for antimycobacterial activity and consider therapeutic drug monitoring.

Elvitegravir/cobicistat639, 623
(Genvoya, Stribild)
150 mg/150 mg150 mg every other dayElvitegravir AUC: decreased 21%; Cmin: decreased 67%25-O-rifabutin AUC: increased 625%; Cmin: increased 494% (compared to 300 mg rifabutin alone)Increased rifabutin effects-

Do not coadminister; consider alternative antiretrovirals.

Antiretroviral (ARV)Dose of ARVDose of RifabutinEffect on ARV LevelsEffect on Rifabutin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Elvitegravir/ritonavir-boosted protease inhibitor697
---Increased AUC of 25-O-desacetyl-rifabutin (metabolite) by 951%Increased rifabutin adverse effects (e.g. uveitis)Inhibition of CYP450 3A4 by ritonavir

Use rifabutin 150mg once daily or 300 mg three times weekly if co-administering with elvitegravir and a ritonavir-boosted PI. Monitor for antimycobacterial activity and consider therapeutic drug monitoring.

Etravirine405
(ETR)(Intelence)
-300 mg QDEtravirine AUC: decreased 37%; Cmax: decreased 37%; Cmin: decreased 35%Rifabutin AUC: decreased 17%; Cmin: decreased 24%; 25-O-desacetylrifabutin AUC: decreased 17%; Cmax: decreased 15%; Cmin: decreased 22%Decreased rifabutin effectsInduction of CYP450 by etravirine

If administered with etravirine and NO protease inhibitor, rifabutin coadministration is acceptable. If etravirine and a protease inhibitor are used together, consider alternate agents to rifabutin if at all possible.

Fosamprenavir420
(FPV)(Lexiva)
700 mg BID with 100 mg ritonavir BID150 mg QODAmprenavir AUC: increased 35%; Cmax: increased 36%;, Cmin: increased 17% (compared to historical controls)Rifabutin: no significant change; Desacetylrifabutin AUC: increased 1010%; Cmin: increased 1020%; Cmax: increased 479%; Rifabutin and metabolite AUC: increased 64% (compared to rifabutin 300 mg QD when given alone)-Inhibition of CYP450 3A4 by fosamprenavir/ritonavir

Dose adjust rifabutin 150 mg once daily or 300 mg three times a week.

Indinavir343
(IDV)(Crixivan)
1000 mg Q8H150 mg QD x 14 daysIndinavir AUC: increased 15%Rifabutin AUC: increased 60% (when compared to rifabutin 300 mg QD monotherapy); 25-desacetyl rifabutin AUC: increased 125% (when compared to 25-desacetyl rifabutin from rifabutin 300 mg QD monotherapy)Increased rifabutin effects (eg, uveitis)Induction of CYP450 3A4 by rifabutin

Decrease rifabutin to 150 mg QD or 300 mg 3 times/week and increase indinavir to 1000 mg Q8H

Indinavir342, 16, 254
(IDV)(Crixivan)
800 mg Q8H300 mg QDIndinavir AUC: decreased 32%Rifabutin AUC: increased 204%Increased rifabutin effects (eg, uveitis); decreased indinavir effectsInhibition of CYP450 3A4 by indinavir; induction of CYP450 3A4 by rifabutin

Decrease rifabutin to 150 mg QD or 300 mg 3 times/week and increase indinavir to 1000 mg Q8H

Indinavir342, 16, 254
(IDV)(Crixivan)
800 mg Q8H x 1 week150 mg QDIndinavir AUC: decreased 31%; AUC of indinavir 800 mg Q8H is comparable to that of 1000 mg Q8H if given with rifabutinRifabutin AUC: increased 60%Increased rifabutin effects (eg, uveitis); decreased indinavir effectsInhibition of CYP450 3A4 by indinavir; induction of CYP450 3A4 by rifabutin

Decrease rifabutin to 150 mg QD or 300 mg 3 times/week and increase indinavir to 1000 mg Q8H

Antiretroviral (ARV)Dose of ARVDose of RifabutinEffect on ARV LevelsEffect on Rifabutin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Indinavir337
(IDV)(Crixivan)
800 mg Q8H x 10 days150 mg QD x 10 daysIndinavir AUC: decreased 32%Rifabutin AUC: increased 54% (compared to 300 mg rifabutin)Increased rifabutin effects (eg, uveitis); decreased indinavir effectsInhibition of CYP450 3A4 by indinavir

Decrease rifabutin to 150 mg QD or 300 mg 3 times/week and increase indinavir to 1000 mg Q8H

Indinavir337
(IDV)(Crixivan)
800 mg Q8H x 10 days300 mg QD x 10 daysIndinavir AUC: decreased 34%Rifabutin AUC: increased 173%Increased rifabutin effects (eg, uveitis); decreased indinavir effectsInhibition of CYP450 3A4 by indinavir

Decrease rifabutin to 150 mg QD or 300 mg 3 times/week and increase indinavir to 1000 mg Q8H

Lopinavir/ritonavir737
(LPV/r)(Kaletra)
400 mg with 100 mg ritonavir x 14 days300 mg daily x 2-4 weeks, then 150 mg every other day x 2 weeks, then 300 mg every other dayNot studiedAUC for Rifabutin 150 mg every other day increased 10% when compared with rifabutin 300 mg daily . AUC for rifabutin 300 mg every other day increased 60% compared to 300 mg daily rifabutin.Potential toxicity from elevated rifabutin levels.-

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
400 mg/100 mg BID x 10 days300 mg QD x 10 days, 150 mg QD x 10 days-Rifabutin AUC: increased 203%; Cmax: increased 112%; Cmin: increased 390%; 25-O-desacetyl rifabutin AUC: increased 4650%; Cmax: increased 2260%; Cmin: increased 9390%Increased rifabutin effects (eg, uveitis)Inhibition of CYP450 3A4 by lopinavir/ritonavir

Use rifabutin dose of 150 mg daily or 300 mg 3times/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
400 mg/100 mg BID x 20 days150 mg QD x 10 daysLopinavir AUC: increased 17%; Cmax: no significant change; Cmin: increased 20%-Increased lopinavir/ritonavir effects-

Use rifabutin dose of 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Nelfinavir24
(NFV)(Viracept)
1250 mg Q12H x 7-8 days150 mg QD x 8 daysNo significant change---

Decrease rifabutin to 150 mg QD or 300 mg 2 to 3 times/week and increase nelfinavir to 1000 mg TID

Antiretroviral (ARV)Dose of ARVDose of RifabutinEffect on ARV LevelsEffect on Rifabutin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Nelfinavir345, 24
(NFV)(Viracept)
750 mg Q8H x 7-8 days150 mg QD x 8 daysNelfinavir AUC: decreased 23%; Cmax: decreased 18%Rifabutin AUC: increased 83%; Cmax: increased 19%Increased rifabutin effects (eg, uveitis); decreased nelfinavir effectsInhibition of CYP450 3A4 by nelfinavir; induction of CYP450 3A4 by rifabutin

Decrease rifabutin to 150 mg QD or 300 mg 2 to 3 times/week and increase nelfinavir to 1000 mg TID

Nelfinavir345, 24
(NFV)(Viracept)
750 mg Q8H x 7-8 days300 mg QD x 8 daysNelfinavir AUC: decreased 32%; Cmax: decreased 25%Rifabutin AUC: increased 207%; Cmax: increased 146%Increased rifabutin effects (eg, uveitis); decreased nelfinavir effectsInhibition of CYP450 3A4 by nelfinavir; induction of CYP450 3A4 by rifabutin

Decrease rifabutin to 150 mg QD or 300 mg 2 to 3 times/week and increase nelfinavir to 1000 mg TID

Nevirapine95
(NVP)(Viramune)
200 mg daily x 14 days; 200 mg150 mg vs 300 mg dailyNevirapine Cmin: decreased 16%AUC increased 17% and 25-O-desacetyl-rifabutin AUC increased 24%Decreased antiviral efficacyInduction of CYP450 3A4 by rifabutin

No dose adjustment necessary

Raltegravir432
(RAL)(Isentress)
400 mg BID300 mg QD x 14 dRaltegravir AUC: increased 19%; Cmax: increased 39%; Cmin: decreased 20%- - -

No dose adjustment necessary

Rilpivirine567
(RPV)(Edurant)
150 mg QD300 mg QDRilpivirine AUC: decreased 46%; Cmin: decreased 49%; Cmax: decreased 35%-Decreased rilpivirine effects-

Do not coadminister

Ritonavir344, 55
(RTV)(Norvir)
300 mg on day 15; 400 mg on day 16; 500 mg on days 17-24150 mg QD x 24 days-Rifabutin AUC: increased 400%; Cmax: increased 250%Increased rifabutin effects (eg, uveitis)Inhibition of CYP450 3A4 by ritonavir

Decrease rifabutin to 150 mg QOD or 300 mg 3 times/week

Antiretroviral (ARV)Dose of ARVDose of RifabutinEffect on ARV LevelsEffect on Rifabutin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Saquinavir75
(SQV)(Fortovase, Invirase)
1200 mg TID300 mg x 1Saquinavir AUC: decreased 47%; Cmax: decreased 39%Rifabutin AUC: increased 44%; Cmax: increased 45%Increased rifabutin effectsinhibition of CYP450 3A4 by saquinavir

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Saquinavir339
(SQV)(Fortovase, Invirase)
400 mg with ritonavir 400 mg BID150 mg Q3D or 300 mg Q7D-Rifabutin weekly AUC: no significant difference between dosing regimensAvoidance of increased rifabutin effectsInhibition of CYP450 3A4 by both ritonavir and saquinavir

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Saquinavir44
(SQV)(Fortovase, Invirase)
600 mg (hard gel caps) TID x 14 days300 mg QD x 14 daysAUC: decreased 43%; Cmax: decreased 30%-Decreased saquinavir effectsInduction of CYP450 3A4 by rifabutin

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Stavudine275
(d4T)(Zerit)
40 mg BID300 mg QDStavudine AUC: no significant change; Cmax: decreased 30%; Cmin: increased 105%---

No dose adjustment necessary

Tipranavir154
(TPV)(Aptivus)
500 mg BID with 200 mg ritonavir BID x 15 doses150 mg x 1 doseNo significant changeRifabutin AUC: increased 190%; Cmax: increased 70%; Cmin: increased 114%; 25-O-desacetyl-rifabutin AUC: increased 1971%; Cmax: increased 220%; Cmin: increased 683%Increased rifabutin effects (eg, uveitis)Inhibition of CYP450 3A4 by tripranavir/ritonavir

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Zidovudine81
(AZT, ZDV)(Retrovir)
-300 mg QD x 7 or 14 daysZidovudine half-life: decreased 28%---

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Rifampin
Antiretroviral (ARV)Dose of ARVDose of RifampinEffect on ARV LevelsEffect on Rifampin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir340
(APV)(Agenerase)
1200 mg BID600 mg QD x 14 daysAUC: decreased 82%No significant changeDecreased amprenavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Amprenavir60
(APV)(Agenerase)
1200 mg BID x 4 days300 mg QD x 4 daysAmprenavir AUC: decreased 82%; Cmax: decreased 70%; Cmin: decreased 92%No significant changeDecreased amprenavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Atazanavir
(ATV)(Reyataz)
----Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Atazanavir247
(ATV)(Reyataz)
300 mg with ritonavir 100 mg QD x 10 d600 mg QD x 10 dAtazanavir AUC: decreased 57%; Cmax: decreased 56%; Cmin: decreased 93%(compared to atazanavir 400 mg QD)-Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister; consider rifabutin

Atazanavir727
(ATV)(Reyataz)
300 mg with ritonavir 100 mg QD x 21 d600 mg QD x 10 dAtazanavir AUC: decreased 72%; Cmax: decreased 53%; Cmin: decreased 98%-Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Antiretroviral (ARV)Dose of ARVDose of RifampinEffect on ARV LevelsEffect on Rifampin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Atazanavir247
(ATV)(Reyataz)
300 mg with ritonavir 200 mg QD x 10 d600 mg QD x 10 dAtazanavir AUC: decreased 31%; Cmax: decreased 40%; Cmin: decreased 80%(compared to atazanavir 400 mg QD)-Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister; consider rifabutin

Atazanavir247
(ATV)(Reyataz)
400 mg with ritonavir 200 mg QD x 10 d600 mg QD x 10 dAtazanavir AUC: no significant change; Cmax: decreased 18%; Cmin: decreased 40%(compared to atazanavir 400 mg QD)-Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister; consider rifabutin

Bictegravir759
(Biktarvy)
75 mg daily600 mg daily (fed state) Cmax decreased 28%; AUC decreased 75% Not studied Potential loss of antiviral efficacyInduction of CYP3A4

Contraindicated. Use alternative agents

Darunavir161
(DRV)(Prezista)
--Not studied; may decrease darunavir/ritonavir levels-Decreased darunavir/ritonavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Delavirdine88
(DLV)(Rescriptor)
400 mg TID600 mg QDDelavirdine AUC: decreased 96%Not studiedDecreased delavirdine effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Dolutegravir641
(Tivicay)
50 mg BID600 mg QDDolutegravir AUC: decreased 54%; Cmin: decreased 72% (when compared to dolutegravir 50 mg BID without rifampin)-Decreased dolutegravir effectiveness-

If no InSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative or consider rifabutin

Antiretroviral (ARV)Dose of ARVDose of RifampinEffect on ARV LevelsEffect on Rifampin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Dolutegravir641
(Tivicay)
50 mg BID600 mg QDDolutegravir AUC: increased 33%; Cmin: increased 22% (when compared to dolutegravir 50 mg QD)---

If no INSTI resistance, increase dolutegravir dosage to 50 mg BID. If known or clinically suspected INSTI resistance, use alternative or consider rifabutin

Efavirenz357
(EFV)(Sustiva)
600 mg QD x 14 days600 mg QD x 14 daysEfavirenz AUC: decreased 22%; Cmax: decreased 24%; Cmin: decreased 25%No significant changeDecreased efavirenz effectsInduction of CYP450 3A4 by rifampin

Dose adjustment not established; may consider increasing efavirenz to 800 mg QD when used with rifampin

Alternative Agents:
Rifabutin

Efavirenz90, 345
(EFV)(Sustiva)
600 mg x 7 days600 mg x 7 daysEfavirenz AUC: decreased 26%; Cmax: decreased 20%- Decreased efavirenz effectsInduction of CYP450 3A4 by rifampin

Dose adjustment not established; may consider increasing efavirenz to 800 mg QD when used with rifampin

Alternative Agents:
Rifabutin

Elvitegravir/cobicistat639, 623
(Genvoya, Stribild)
-- Expected decrease in elvitegravir and cobicistat levels-Potential loss of antiretroviral efficacyInduction of CYP450 by rifampin

Do not coadminister; consider alternative antiretrovirals

Elvitegravir/ritonavir-boosted protease inhibitor639
--Expected significant decrease in elvitegravir, cobicistat, and protease inhibitor levels-Potential loss of antiretroviral efficacyInduction of CYP3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Enfuvirtide6,
(ENF)(Fuzeon)
90 mg SQ BID on days 1-3 and 11-13600 mg QD on days 4-13No significant changeNo significant change--

No dose adjustment necessary

Antiretroviral (ARV)Dose of ARVDose of RifampinEffect on ARV LevelsEffect on Rifampin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Indinavir16
(IDV)(Crixivan)
800 mg Q8H x 1 week600 mg QD x 1 weekIndinavir AUC: decreased 89%-Decreased indinavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Indinavir353
(IDV)(Crixivan)
800 mg with ritonavir 100 mg BID300 mg QD x 4 daysIndinavir Cmin: decreased 87%; Cmax: no significant change; half-life: decreased 39%;Ritonavir Cmin: decreased 94%; Cmax: decreased 38%; half-life: decreased 53%Not studiedDecreased indinavir and ritonavir effectsInduction of P450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Indinavir355
(IDV)(Crixivan)
800 mg with ritonavir 100 mg BID x 1, administered with food- Indinavir AUC: decreased 81%; ritonavir AUC: decreased 89%Rifampin AUC: increased 25%; desacetylrifampin AUC: increased 63%Increased rifampin effects; decreased indinavir and ritonavir effectsInduction of CYP450 3A4 by rifampin; inhibition of CYP450 3A4 by indinavir/ritonavir

Do not coadminister

Alternative Agents:
Rifabutin

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
400 mg/100 mg BID x 20 days600 mg QD x 10 daysLopinavir AUC: decreased 75%; Cmax: decreased 55%; Cmin: decreased 99%-Decreased lopinavir/ritonavir effectsInduction of CYP450 3A4 by rifampin

Avoid coadministration. If combination can not be avoided consider alternate dosing for lopinavir/ritonavir (800/200 mg Q12H) or additional ritonavir.

Alternative Agents:
Rifabutin

Lopinavir/ritonavir351, 350, 352
(LPV/r)(Kaletra)
400/100 mg BID on days 1-15, then 800/200 mg BID or 400/400 mg BID on days 16-24600 mg QD on days 11-24Lopinavir AUC: decreased 16% (in 800/200 mg BID group when compared to 400/100 mg BID); Cmin: decreased 57%; Cmax: no significant change. Ritonavir AUC: increased 42%; Cmax: increased 75%; Cmin: no significant change.Lopinavir pharmacokinetics: No significant change (in 400/400 mg BID group)Ritonavir AUC: increased 612%; Cmax: increased 738%; Cmin: increased 389% (in 400 mg/400 mg BID group)Not studiedDecreased lopinavir effectsInhibition of CYP450 3A4 by ritonavir; Induction of CYP450 3A4 by rifampin

Avoid coadministration. If combination can not be avoided consider using lopinavir/ritonavir 400 mg BID with ritonavir 400 mg BID when coadministering with rifampin

Lopinavir/ritonavir459
(LPV/r)(Kaletra)
400/100 mg Q12h x 7 days, 600/150 mg Q12H x 7 days then 800/200 Q12H x 7 days600 mg QDLopinavir AUC: decreased 71% (on 400/100 mg Q12H); AUC: decreased 40% (on 600/150 mg Q12H); AUC: no significant change (on 800/200 mg Q12H)-Decreased lopinavir effects at lower dosagesInduction of CYP450 3A4 by rifampin

Avoid coadministration. If combination can not be avoided lopinavir/ritonavir dosage of 800/200 mg Q12H appears to compensate for rifampin induced 3A4 induction

Antiretroviral (ARV)Dose of ARVDose of RifampinEffect on ARV LevelsEffect on Rifampin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Maraviroc2
(MVC)(Selzentry)
100 mg BID600 mg QDMaraviroc AUC: decreased 63%; Cmax: decreased 67%; Cmin: decreased 78%- Decreased maraviroc effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Nelfinavir254, 24
(NFV)(Viracept)
750 mg Q8H x 5-6 days600 mg QD x 8 daysNelfinavir AUC: decreased 82%; Cmax: decreased 76%-Decreased nelfinavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Nevirapine95, 351
(NVP)(Viramune)
--Nevirapine Cmin: decreased 37%Not studiedDecreased nevirapine effectsInduction of CYP450 3A4 by rifampin

Avoid if possible

Alternative Agents:
Rifabutin

Nevirapine
(NVP)(Viramune)
200 mg BID600 mg QDNevirapine AUC: decreased 27% (at week 4); Nevirapine AUC: no significant change (at week 10)Nevirapine AUC with rifampicin approximates nevirapine baseline without rifampicin at week 10.-Decreased nevirapine effects-

Regimen most appropriate for countries where rifabutin is not available; Avoid nevirapine and rifampicin/rifampin if rifabutin is available (rifabutin preferred agent)

Alternative Agents:
Rifabutin

Nevirapine356, 351
(NVP)(Viramune)
200 mg BID600 mg QDNevirapine AUC: decreased 31%; Cmax: decreased 36%; Cmin: decreased 21%No significant changeDecreased nevirapine effectsInduction of CYP450 3A4 by rifampin

Avoid if possible

Alternative Agents:
Rifabutin

Nevirapine347
(NVP)(Viramune)
200 mg x 1450 mg if &lt; 55 kg and 600 mg if &gt; 55 kg x 7 daysNevirapine AUC: decreased 79%; Cmax: decreased 20%; Cmin: decreased 60%; half-life: decreased 66%-Decreased nevirapine effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Antiretroviral (ARV)Dose of ARVDose of RifampinEffect on ARV LevelsEffect on Rifampin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Raltegravir438
(RAL)(Isentress)
400 mg QD x 1600 mg QDRaltegravir AUC: decreased 40%; Cmin: decreased 61%; Cmax: decreased 38%-Decreased raltegravir effectsInduction of UGT1A1 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Raltegravir436, 3
(RAL)(Isentress)
400 mg x 1600 mg QDRaltegravir AUC: decreased 40%; Cmax: decreased 38%; Cmin: decreased 61%-Possibly decreased raltegravir effectsInduction of UGT 1A1

Do not coadminister

Alternative Agents:
Possibly rifabutin

Raltegravir3
(RAL)(Isentress)
800 mg BID600 mg QDRaltegravir AUC: increased 27%; Cmax: increased 62%; Cmin: decreased 53% (all compared to raltegravir 400 mg BID)--Induction of UGT1A1 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Raltegravir418
(RAL)(Isentress)
800 mg Q12H600 mg QDRaltegravir AUC: increased 27%; Cmin: decreased 53%; Cmax: increased 62% (compared to 400 mg raltegravir Q12H when given alone)- - -

Use caution if this combination must be used

Alternative Agents:
Rifabutin

Rilpivirine567
(RPV)(Edurant)
150 mg QD600 mg QDRilpivirine AUC: decreased 80%; Cmin: decreased 89%; Cmax: decreased 69%No significant changeDecreased rilpivirine effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Ritonavir197, 55
(RTV)(Norvir)
500 mg Q12H x 20 days300 mg or 600 mg x 10 daysRitonavir AUC: decreased 35%; Cmax: decreased 25%-Decreased ritonavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Antiretroviral (ARV)Dose of ARVDose of RifampinEffect on ARV LevelsEffect on Rifampin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Saquinavir282
(SQV)(Fortovase, Invirase)
1200 mg TID600 mg QD x 14 daysSaquinavir AUC: decreased 46%; Cmax: decreased 43% when studied in HIV-infected patients-Decreased saquinavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Saquinavir282
(SQV)(Fortovase, Invirase)
1200 mg TID600 mg QD x 14 daysSaquinavir AUC: decreased 70%; Cmax: decreased 65%-Decreased saquinavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Saquinavir44, 351
(SQV)(Fortovase, Invirase)
600 mg (hard gel caps) TID x 14 days600 mg QD x 7 daysAUC: decreased 84%; Cmax: decreased 79%-Decreased saquinavir effectsInduction of CYP450 3A4 by rifampin

Avoid if possible; may consider saquinavir 400 mg BID with ritonavir 400 mg BID

Alternative Agents:
Rifabutin

Tenofovir disoproxil fumarate348, 349
(TDF)(Viread)
300 mg QD on days 1-20600 mg QD on days 11-21No significant changeNo significant change--

No dose adjustment necessary

Zidovudine81
(AZT, ZDV)(Retrovir)
200 mg QD600 mg QDZidovudine AUC: decreased 48%---

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Rifapentine
Antiretroviral (ARV)Dose of ARVDose of RifapentineEffect on ARV LevelsEffect on Rifapentine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Dolutegravir691
(Tivicay)
--Not studied; may decrease dolutegravir levels-Potentially decreased dolutegravir effectiveness-

Contraindicated - do not coadminister

Efavirenz681
(EFV)(Sustiva)
600 mg QD900 mg Q weekEfavirenz AUC: decreased 14%; Cmin: decreased 15%---

No dose adjustment necessary

Elvitegravir/cobicistat
(Genvoya, Stribild)
-- Expected significant decrease in elvitegravir and cobicistat levels- Potential loss of antiretroviral efficacy-

Do not coadminister

Elvitegravir/ritonavir-boosted protease inhibitor
-- Expected significant decrease in elvitegravir and cobicistat levels- Potential loss of antiretroviral efficacy-

Do not coadminister

Indinavir335, 336
(IDV)(Crixivan)
800 mg TID x 14 days600 mg twice a week x 14 daysIndinavir AUC: decreased 70%; Cmax: decreased 55%No significant changeDecreased indinavir effectsInduction of CYP450 3A4 by rifapentine

Dosage adjustment not established

Alternative Agents:
Rifabutin

Nelfinavir336
(NFV)(Viracept)
- - Not studied; may decrease nelfinavir levels- Decreased nelfinavir effectsInduction of CYP450 3A4 by rifapentine

Do not coadminister

Alternative Agents:
Rifabutin

Raltegravir589
(RAL)(Isentress)
400 mg BID900 mg PO once weeklyRaltegravir AUC: increased 73%; Cmax: increased 89%; Cmin: decreased 44%---

Do not coadminister

Raltegravir693
(RAL)(Isentress)
400 mg BID900 mg once weekly for 3 weeks or 600 mg once daily for 10 scheduled doses (days 1, 4–8 and 11–14)When given with rifapentine once weekly for 3 weeks raltegravir AUC increased 79%, Cmax increased 89% and Cmin decreased 12%. When given with rifapentine for 10 daily doses, Cmin decreased 41% - Potential for increased raltegravir adverse effects if given with rifapentine once weekly; potential for decreased raltegravir effectiveness if rifapentine co-administered daily-

Avoid co-administration

"-" indicates that there are no data available
Interactions with Sulfamethoxazole
Antiretroviral (ARV)Dose of ARVDose of SulfamethoxazoleEffect on ARV LevelsEffect on Sulfamethoxazole LevelsPotential Clinical EffectsMechanism of InteractionManagement
Didanosine84
(ddI)(Videx)
200 mg (buffered formulation) x 1 dose1000 mg x 1 doseNo significant changeNo significant change--

No dose adjustment necessary

Indinavir
(IDV)(Crixivan)
------

-

"-" indicates that there are no data available
Interactions with Tinidazole
Antiretroviral (ARV)Dose of ARVDose of TinidazoleEffect on ARV LevelsEffect on Tinidazole LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir329, 60
(APV)(Agenerase)
Oral solution (contains propylene glycol)- - - Propylene glycol toxicity (eg, acidosis, CNS depression)Inhibition of alcohol and aldehyde dehydrogenase by tinidazole

Do not coadminister with amprenavir oral solution

Alternative Agents:
Amprenavir capsules

Lopinavir/ritonavir329
(LPV/r)(Kaletra)
Oral solution (contains alcohol)- - - Disulfiram like reaction (eg, nausea, vomiting, headache, hypotension)Inhibition of alcohol and aldehyde dehydrogenase by tinidazole

Do not coadminister; may consider lopinavir/ritonavir capsules

Ritonavir328
(RTV)(Norvir)
Oral solution (contains alcohol) and capsules- - - Disulfiram-like reaction (eg, headache, hypotension, flushing, vomiting)Inhibition of alcohol and aldehyde dehydrogenase by tinidazole

Do not coadminister

"-" indicates that there are no data available
Interactions with Trimethoprim
Antiretroviral (ARV)Dose of ARVDose of TrimethoprimEffect on ARV LevelsEffect on Trimethoprim LevelsPotential Clinical EffectsMechanism of InteractionManagement
Didanosine84, 19
(ddI)(Videx)
200 mg (buffered formulation) x 1 dose200 mg x 1 doseDidanosine AUC: no significant change; Cmax: increased 17%Trimethoprim AUC: no significant change; Cmax: decreased 22%--

No dose adjustment necessary

"-" indicates that there are no data available
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