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 Class||No Food Restrictions||Take with Food||Take on Empty Stomach|
|NRTI||ddI: gastric acid impairs absorption; take 30 minutes before or 2 hours after a meal (if coadministered with TDF, may be taken with food)|
|PI||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|
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.