for Health Care Providers
Updates to the Database of ARV Drug Interactions
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.
| Drug One | Drug Two | Clinical Effects | Mechanisms | Management |
|---|---|---|---|---|
| Source: McNicholl I. HIV InSite Database of Antiretroviral Drug Interactions. University of California San Francisco: Center for HIV Information; 2009 | ||||
| Darunavir | Buprenorphine | Inhibition of CYP 3A4 by darunavir/ritonavir | No dosage adjustment necessary | |
| Darunavir | Digoxin | Monitor digoxin level and adjust digoxin dosage based on clinical signs and digoxin level | ||
| Darunavir | Omeprazole | No dosage adjustment necessary | ||
| Darunavir | Rifabutin | Inhibition of CYP 3A4 by darunavir/ritonavir | No dosage adjustment necessary; potentially could use rifabutin 150 mg QOD | |
| Darunavir | Warfarin | ↓ warfarin effects (eg, ↓ INR, ↑ risk of clotting) | Induction of CYP 3A4 by darunavir | Monitor INR and adjust warfarin as indicated |
| Efavirenz | Levonorgestrel | ↓ levonorgestrel effects | Induction of levonorgestrel metabolism by efavirenz | Use backup form of birth control (eg, barrier) |
| Etravirine | Clopidogrel | Possibly ↓ clopidogrel effects | Activation of clopidogrel to its active metabolites may be ↓ by etravirine | Avoid combination; consider alternative agents |
| Etravirine | Fluconazole | ↑ etravirine effects | Inhibition of CYP 3A4 by fluconazole | Dosage adjustment not established |
| Etravirine | Lopinavir/ritonavir | Potentially ↓ etravirine effects | Potential induction of CYP 3A4, 2C9, and 2C19 by lopinavir/ritonavir | No dosage adjustment necessary |
| Etravirine | Voriconazole | Possibly ↑ etravirine effects | Inhibition of CYP 3A4 by voriconazole | No dosage adjustment necessary |
| Fosamprenavir | Posaconazole | ↓ posaconazole and fosamprenavir efficacy | Do not coadminister | |
| Indinavir | Ginseng | No dosage adjustment necessary | ||
| Lopinavir/ritonavir | Buprenorphine | No significant change | No dosage adjustment necessary | |
| Lopinavir/ritonavir | Naloxone | No significant change | No dosage adjustment necessary | |
| Nevirapine | Lumefantrine | Unknown | No dosage adjustment necessary | |
| Nevirapine | Tenofovir | Potential early virologic failure | Use caution when coadministering tenofovir, didanosine, and either efavirenz or nevirapine in treatment-naive patients | |
| Raltegravir | Famotidine | Possibly owing to increased bioavailability because of ↑ gastric pH | No dosage adjustment necessary | |
| Raltegravir (400 mg BID) | Omeprazole (20 mg QD) | Possibly owing to increased bioavailability because of ↑ gastric pH | No dosage adjustment necessary | |
| Raltegravir (400 mg Q12H) | Omeprazole (20 mg QD x 4 days) | Possibly owing to increased bioavailability because of ↑ gastric pH | No dosage adjustment necessary | |
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