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Food and Supplements: ARV Interactions

for Health Care Providers

Food and Supplements: ARV Interactions

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

ARVs: Food Requirements

ARV ClassNo Food RestrictionsTake with FoodTake on Empty Stomach
  • 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)
  • 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
  • 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 InhibitorRAL
Entry Inhibitor
  • ENF
  • MVC

Print table

ARV Interactions with Specific Foods, Nutritionals, Herbs

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.