for Health Care Providers

Food and Supplements: ARV Interactions

Primary Care of Veterans with HIV

Drug Tables

April 2009; Last reviewed/updated: October 28, 2011

Note: Some medications mentioned in this chapter may not be available on the VHA National Formulary. Consult VA pharmacists for alternatives.

ARV Class	No Food Restrictions	Take with Food	Take on Empty Stomach
NRTI	3TC ABC d4T FTC TDF ZDV		ddI: gastric acid impairs absorption; take 30 minutes before or 2 hours after a meal (if coadministered with TDF, may be taken with food)
NNRTI	DLV NVP	ETR: take after a meal RPV: take with a full meal	EFV: fat increases absorption and may increase the risk of EFV adverse effects RPV: gastric acid required for absorption; in addition, RPV levels significantly decreased if not taken with full meal
PI	FPV LPV/r (tablets) TPV	ATV DRV NFV RTV SQV	IDV: heavy meals interfere with absorption; if unboosted, IDV should be taken 1 hour before or 2 hours after a meal; may be taken with a light, nonfatty, snack; if boosted with RTV, IDV may be taken with or without food
Integrase Inhibitor	RAL
Entry Inhibitor	ENF MVC

Calcium (other divalent cations): May interfere with activity of integrase.
Separate dosing by 2 hours.

Garlic: Capsules ↓ SQV (unboosted) levels. Avoid.

Grapefruit juice: ↑ SQV levels. Separate dosing by 2 hours.
↓ IDV levels. Monitor virologic response.

St. John's wort: ↓ levels of all NNRTIs and PIs. Avoid with PIs and NNRTIs.
↓ levels of MVC; increase MVC dosage to 600 mg BID.

Vitamin E: ↑ risk of bleeding associated with TPV. Avoid.

Echinacea, ginseng, milk thistle, vitamin C: no interactions.