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GERD: Potential ARV Interactions

for Health Care Providers

Table 2: Potential ARV Interactions

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Acid-lowering medications have interactions with various ARVs. Consult dosing information, as certain combinations require specific dosing strategies, and some are contraindicated.

PPIs: interactions with ARVs are incompletely studied

  • All PPIs:
    • PIs
      • ↓ ATV levels (ATV requires an acidic GI environment for absorption); see specific dosing recommendations below
      • ↓ IDV (predicted)
    • NNRTIs
      • ↓ RPV levels (RPV requires an acidic GI environment for absorption; coadministration is not recommended)
    • Integrase inhibitors
      • ↑ RAL levels
  • Omeprazole (in addition to ARVs listed above):
    • ↓ NFV, ETV
    • ↓ ETR, SQV

H2RAs:

  • All H2RAs:
    • ATV: ↓ ATV levels (ATV requires an acidic GI environment for absorption); see specific dosing recommendations below
    • RPV: may ↓ RPV levels (RPV requires an acidic GI environment for absorption); if used concurrently, must give H2RA at least 12 hours before or at least 4 hours after RPV
    • RAL: may ↑ RAL levels
  • Cimetidine (in addition to All H2RAs, above):
    • ↓ NVP levels; dosage adjustment not established
    • May ↑ FPV levels; consider alternative agents
    • May ↓ DRV levels
  • Ranitidine
    • May ↓ FPV and LPV/r levels; dosage adjustments not established

Antacids

  • All antacids: May ↓ levels of RPV; give antacids at least 2 hours before or 4 hours after RPV
  • Maalox, Mylanta, Tums, milk of magnesia, others
    • May ↓ levels of ATV, FPV, TPV; separate dosing by 2 hours
  • Calcium (eg, Tums, Mylanta)
    • May bind integrase inhibitors and interfere with their activity (until further information is available, separate dosing by at least 2 hours)

From Gastroesophageal Reflux Disease
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009