POSITIVELY AWARE MARCH/APRIL 2011
Do your meds play well with others?
A guide to HIV drug interactions
by Swarup Mehta, PharmD and Enid Vázquez
For details, read the drug’s page in the Drug Guide, or refer to the manufacturer’s package insert for a full comprehensive list of potential drug interactions. Also, make your pharmacist and health care providers aware of any drug that you add. Some interactions are more serious than others; some drugs may only require a dose adjustment, while others may either render the drug completely ineffective, or worse, lead to a potentially fatal reaction.
Discuss any changes, however minor, with your health care providers, including your pharmacist, since small reactions may become serious. Look up your drugs with “Check my meds” at www.aidsmeds.com/cmm, which lists the effect of food as well as interactions for medications. The University of Liverpool also has an interactive database that allows you to look up antiretroviral drug interactions and has PDF charts of interactions between antiretrovirals and other drugs. Remember, brand names are usually capitalized, while generic names are not. Go to www.hiv-druginteractions.org.
| NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS also called nucleoside analogs, NRTIs, or nukes |
|
 Potential drug class interactions |
None. |
| Combivir (Retrovir and Epivir) |
See Epivir and Retrovir (zidovudine). Do not take Atripla, Emtriva, Epivir, Epivir-HBV, Epzicom, Retrovir (zidovudine), rilpivirine/Truvada, Trizivir, or Truvada, since all or part of these medications are already in Combivir or have equivalent medications. |
| Emtriva (emtricitabine, or FTC) |
No significant drug interactions. Do not take Emtriva with Atripla, Combivir, Epivir, Epivir-HBV, Epzicom, rilpivirine/Truvada, Trizivir, or Truvada, since they contain Emtriva or medication equivalent to Emtriva. |
| Epivir (lamivudine, or 3TC) |
No significant drug interactions. Do not take Atripla, Combicir, Emtriva, Epivir-HBV, Epzicom, Trizivir, or Truvada, while taking Epivir, since they contain Epivir or medication equivalent to it. |
| Epzicom (Epivir and Ziagen) |
See Epivir and Ziagen. Do not take Atripla, Combivir, Emtriva, Epivir, Epivir-HBV, rilpivirine/Truvada Trizivir, or Truvada, while taking Epzicom, since all or part of these medications are already in Epzicom or have equivalent medications. |
| Retrovir (zidovudine, or AZT) |
Do not take with Combivir or Trizivir, since zidovudine is already in these medications. Amphotericin B, Benemid, Biaxin, dapsone, Depakote, doxorubicin, flucytosine, ganciclovir, hydroxyurea, interferon-alpha, methadone, pentamidine, phenytoin (Dilantin), ribavirin, rifampin, sulfadiazine, Valcyte, and Zerit. |
| Trizivir (Epivir, Retrovir, and Ziagen) |
See Epivir, Retrovir, and Ziagen. Do not take Atripla, Emtriva, Epivir, Epivir-HBV, Epzicom, Ziagen, Retrovir (zidovudine), or Truvada while taking Trizivir, since all or part of these medications are already in Trizivir or have equivalent medications. |
| Truvada (Viread and Emtriva) |
See Emtriva and Viread. Do not take with Atripla, Combivir, Emtriva, Epivir, Epivir-HBV, Epzicom, rilpivirine/Truvada Trizivir, or Viread, since all or part of these medications are already in Truvada or have equivalent medications. |
| Videx & Videx EC (didanosine, or ddI) |
Alcohol, allopurinol, cimetidine, dapsone, ganciclovir, HIV protease inhibitors, hydroxyurea, itraconazole, ketoconazole, methadone, pentamidine, Rescriptor, Retrovir (zidovudine), ribavirin, valganciclovir, Viread, and Zerit. |
| Viread (tenofovir) |
Do not take with Atripla, rilpivirine/Truvadam or Truvada since Viread is in these medications. Hepsera, Kaletra, Norvir, Reyataz, Videx and Videx-EC. |
| Zerit (stavudine, or d4T) |
Amphotericin B, dapsone, foscarnet, ganciclovir, pentamidine, Valcyte, Videx and Videx-EC, and Retrovir (zidovudine). |
| Ziagen (abacavir sulfate) |
Do not take with Epzicom or Trizivir, since Ziagen is already in these medications. Alcohol and methadone. |
| NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS also called non-nucleosides, NNRTIs, or non-nukes |
|
| Potential drug class interactions |
Anti-convulsants; HIV protease inhibitors; methadone. |
| Intelence (etravirine, or ETR) |
Aptivus/Norvir, Atripla, Biaxin, Cialis, Coumadin (warfarin), diazepam, Dilantin (phenytoin), fluconazole, Kaletra, Lexiva/Norvir, Mycobutin, Levitra, Norvir, phenobarbital, Plavix, Rescriptor, Reyataz/Norvir, rifampin, rilpivirine, Selzentry, St. John’s wort, Sustiva, Tegretol (carbamazepine), Viagra, Viramune, voriconazole, and unboosted (without Norvir) PIs. |
| Rescriptor (delavirdine, or DLV) |
Agenerase, amlodipine, certain amphetamines and antiarrhythmic drugs, Atripla, Biaxin, birth control pills, Cialis, cisapride, Coumadin (warfarin), Crixivan, dapsone, Dilantin (phenytoin), ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), felodipine, fluticasone (Advair, Flonase, Flovent), immunosuppressants, Intelence, Invirase, Kaletra, Levitra, Lexiva, methadone, lovastatin, midazolam, Mycobutin, nifedipine, Norvir, phenobarbital, pimozide, Propulsid, quinidine, Reyataz, rifampin, rilpivirine, simvastatin, St. John’s wort, Sustiva, Tegretol (carbamazepine), trazodone, triazolam, Viagra, Viracept, Viramune, Vytorin, and Xanax (alprazolam). |
| rilpivirine (TMC-278) |
Methadone. Atripla, Intelence, Rescriptor, Sustiva, and Viramune. Available data is limited due to its experimental drug status at press time. |
| Sustiva (efavirenz, or EFV) |
Do not take with Atripla, since Sustiva is already in Atripla. Bepridil, Biaxin, birth control pills, buprenorphine, bupropion, Coumadin (warfarin), Crixivan, Dilantin (phenytoin), diltiazem, ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), Gingko biloba, immunosuppressants, Intelence, Invirase, itraconazole, Kaletra, Lexiva, Lipitor, Malarone, methadone, midazolam, Mycobutin, Norvir, Noxafil (posaconazole), pimozide, pravastatin, Rescriptor, Reyataz, rifampin, rilpivirine, phenobarbital, pravastatin, sertraline, simvastatin, St. John’s wort, Tegretol (carbamazepine), triazolam, Vfend, Viramune, and Zoloft. |
| Viramune (nevirapine) |
Atripla, Biaxin, birth control pills, calcium channel blockers (Adalat, Norvasc, Procardia, and others), cisapride, clonazepam, Cordarone, Coumadin (warfarin), Crixivan, Dilantin (phenytoin), disopyramide, ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), ethosuxomide, flucanozole, immunosuppressants, Intelence, Invirase, Kaletra, ketoconazole, Lexiva, lidocaine, methadone, midazolam, Mycobutin, Norvir, phenobarbital, prednisone, Rescriptor, Reyataz, rifampin, rilpivirine, St. John’s wort, Sustiva, Tegretol (carbamazepine), and triazolam. |
| FIXED DOSE REGIMENS | |
| Atripla (Sustiva/Truvada) |
See Sustiva and Truvada (Emtriva/Viread). Do not take Combivir, Emtriva, Epivir, Epivir-HBV, Epzicom, rilpivirine/Truvada , Sustiva, Trizivir, Truvada, or Viread while taking Atripla, since all or part of these medications are already in Atripla or have equivalent medications. |
| rilpivirine/Truvada | See rilpivirine and Truvada. Do not take Atrilpa, Combivir, Emtriva, Epivir, Epivir-HBV, Epzicom, rilpivirine, Sustiva, Trizivir, Truvada, or Viread while taking rilpivirine/Truvada, since all or part of these medications are already in ril pivirine/Truvada or have equivalent medications. Available data is limited due to its experimental drug status at press time. |
| PROTEASE INHIBITORS (PIs) | |
| Potential drug class interactions |
Cardiac medications, cholesterol medications, dexamethasone, erectile dysfunction drugs, ergot derivatives (vasoconstrictors), migraine medications, sedatives, tuberculosis drugs. |
| Aptivus (tipranavir, or TPV) (must be taken with Norvir) |
There are many interactions—see the package insert for the most complete list and tell your health care professional about all the medications you are taking. Advicor, alfuzosin, Altoprev, antacids, birth control pills, bosentan, buprenorphine, bupropion, calcium channel blockers (Adalat, Norvasc, Procardia, and others), Cialis, colchicine, Coumadin (warfarin), Crestor, ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), disulfirum (Antabuse), Flagyl, fluconazole, fluticasone (Advair, Flonase, Flovent), Fuzeon, other HIV protease inhibitors, immunosuppressants, itraconazole, ketoconazole, Lescol, Levitra, Lipitor, Livalo, lovastatin, methadone, midazolam (oral), Mycobutin, Paxil, phenobarbital, phenytoin (Dilantin and others), pimozide, pravastatin, Prilosec (omeprazole), quinidine, Revatio, rifabutin, rifampin, Rythmol, salmeterol, simvastatin, St. John’s wort, Suboxone, Tambocor, Tegretol (carbamazepine), trazodone, triazolam, valproic acid, Viagra, vitamin E, Videx, Vytorin, Ziagen, Retrovir (zidovudine), and Zoloft. |
| Crixivan (indinavir sulfate, or IDV) |
Advicor, alfuzosin, Altoprev, birth control pills, bosentan, calcium channel blockers (Adalat, Norvasc, Procardia, and others), Cialis, coffee or alcohol (and other diuretics), colchicine, Cordarone, Coumadin (warfarin), Dilantin (phenytoin), ergot alkaloids (Cafergot, D.H.E. 45, Livalo, Methergine, Wigraine), fluticasone (Advair, Flonase, Flovent), garlic supplements, grapefruit juice, itraconazole, immunosuppressants, ketoconazole, Lescol, Levitra, Lipitor, lovastatin, methadone, midazolam, Mycobutin, phenobarbitol, pimozide, pravastatin, Rescriptor, Revatio, Reyataz, rifampin, Rythmol, salmeterol, simvastatin, St. John’s wort, Sustiva, Tambocor, Tegretol (carbamazepine), trazodone, triazolam, Viagra, Viramune, vitamin C, and Vytorin. |
| Invirase (saquinavir, or SQV) (must be taken with Norvir) |
Advicor, alfuzosin, Altoprev, Aptivus/Norvir, Biaxin, birth control pills, bosentan, Cialis, colchicine, Cordarone, Coumadin (warfarin), Crestor, Crixivan, digoxin, ergot alkaloids (Cafergot, D.H.E. 45, Livalo, Methergine, Wigraine), dapsone, dexamethasone, fluticasone (Advair, Flonase, Flovent), garlic supplements, Kaletra, Lanoxin, Lescol, Levitra, Lipitor, lovastatin, methadone, midazolam (oral), Mycobutin, Nizoral, Norvir, pimozide, pravastatin, quindine, rifampin, Rescriptor, Revatio, Reyataz, rifampin, Rythmol, salmeterol, simvastatin, St. John’s wort, Sporanox, Sustiva, Tambocor, trazodone, triazolam, Viagra, Viracept, Viramune, and Vytorin. |
| Kaletra (lopinavir/ritonavir, or LPV/r) |
Advicor, alfuzosin, Altoprev, anti-convulsants, Biaxin, birth control pills, bosentan, bupropion, certain calcium channel blockers, Cialis, colchicine, Cordarone, Coumadin (warfarin), digoxin, Dilantin (phenytoin), ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), Flagyl, fluticasone (Advair, Flonase, Flovent), garlic supplements, immunosuppressants, itraconazole, Lescol, Levitra, Lexiva, Lipitor, Livalo, lovastatin, Mepron, methadone, midazolam (oral), Mycobutin, nifedipine, pimozide, phenobarbital, pravastatin, rifampin, Retrovir, Revatio, Rythmol, salmeterol, simvastatin, St. John’s wort, steroids (especially Decadron), Sustiva, Tegretol (carbamazepine), trazodone, triazolam, Uroxatral, Viagra, Videx, Viracept, Viramune, Vytorin, and Ziagen. |
|
Lexiva (fosamprenavir calcium, or FPV) |
Advicor, alfuzosin, Altoprev, birth control pills, bosentan, calcium channel blockers, Cialis, colchicine, Coumadin (warfarin), Crestor, disulfirum (Antabuse), ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), Flagyl, fluticasone (Advair, Flonase, Flovent), Kaletra, Lipitor, Lescol, Levitra, Livalo, lovastatin, Paxil, pimozide, pravastatin, Rescriptor, Revatio, Rythmol, methadone, midazolam (oral), Mycobutin, rifampin, salmeterol, simvastatin, St. John’s wort, steroids (especially Decadron), Sustiva, Tambocor, trazodone, triazolam, Viagra, and Vytorin. |
| Norvir (ritonavir. or RTV) |
See the manufacturer package insert for the most complete list. Advicor, alcohol, alfuzosin, Altoprev, Biaxin, birth control pills, bosentan, Cialis, colchicine, Cordarone, Dilantin (phenytoin), disulfiram (Antabuse), Ecstasy, ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), Flagyl, fluticasone (Advair, Flonase, Flovent), garlic supplements, GHB, immunosuppressants, Lescol, Levitra, Lipitor, lovastatin, midazolam (oral), methadone, phenobarbital, pimozide, pravastatin, rifampin, Revatio, Rythmol, salmeterol, simvastatin, St. John’s wort, Tambocor, Tegretol (carbamazepine), tobacco, trazodone, triazolam, Uroxatral, Viagra, and Vytorin. |
| Prezista (darunavir, or DRV) (must be taken with Norvir) |
Advicor, alfuzosin, Altoprev, Biaxin, birth control pills, bosentan, calcium channel blockers (Norvasc, Procardia, and others), Cialis, cisapride, colchicine, Coumadin (warfarin), Crestor, desimpramine, Dilantin (phenytoin), ergot alkaloids (Cafergot, D.H.E. 45, Ergomar, ergonovine, methylergonovine, Migranal), fluticasone (Advair, Flonase, and Flovent), immunosuppressants, Invirase, itraconazole, Kaletra, ketoconazole, Levitra, Lipitor, Livalo, lovastatin, methadone, Mevacor, midazolam (oral), nifedipine, Paxil, pimozide, phenobarbital, pravastatin, Revatio, rifabutin, rifampin, salmeterol, Simcor, simvastatin, St. John’s wort, Suboxone, Subutex, Tegretol (carbamazepine), trazodone, triazolam, Vfend, Viagra, Vytorin, and Zoloft. |
| Reyataz (atazanavir sulfate, or ATV) |
Advicor, alfuzosin, Altoprev, antacids (including Axid, Rolaids, Tums, Mylanta, Pepcid, and Zantac), bepridil, birth control pills, bosentan, buprenorphine, calcium channel blockers (Adalat, Norvasc, Procardia, and others), Cialis, colchicine, Coumadin (warfarin), Cordarone, Crixivan, Camptosar, Dilantin (phenytoin), ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), fluticasone (Advair, Flonase, Flovent), garlic supplements, immunosuppressants, itraconazole, ketoconazole, Lescol, Levitra, lidocaine, Lipitor, Livalo, lovastatin, midazolam (oral), Mylanta, pimozide, pravastatin, proton-pump inhibitors (Aciphex, Nexium, Prevacid, Prilosec OTC), quinidine, Revatio, rifabutin, rifampin, salmeterol, simvastatin, St. John’s wort, Sustiva, triazolam, trazodone, Vfend, Viagra, Videx and Videx-EC, Viread, and Vytorin. |
| Viracept (nelfinavir, or NFV) |
Advicor, alfuzosin, Altoprev, birth control pills, bosentan, Cialis, colchicine, Cordarone, Crixivan, ergot alkaloids (Cafergot, D.H.E. 45, Methergine, Wigraine), fluticasone (Advair, Flonase, Flovent), garlic supplements, immunosuppressants, Invirase, Lescol, Levitra, Lipitor, Livalo, lovastatin, methadone, midazolam (oral), Mycobutin, phenobarbital, phenytoin (Dilantin and others), pravastatin, Prilosec OTC, Revatio, rifampin, salmeterol, simvastatin, St. John’s wort, Tegretol (carbamazepine), triazolam, trazodone, Viagra, and Vytorin. |
| ENTRY INHIBITORS | |
| Fuzeon (enfuvirtide, or T-20) |
None found to be clinically significant. |
| Selzentry (maraviroc, or MVC) |
Biaxin, Coumadin (warfarin), Intelence, Invirase, itraconazole, Kaletra, ketoconazole, midazolam (oral), Mycobutin, Norvir, Reyataz, rifampin, St. John’s wort, Sustiva, Tegretol (carbamazepine), Vfend, and Viramune. |
| INTEGRASE INHIBITOR | |
| Isentress (raltegravir, or RAV) |
Aptivus/Norvir, Prilosec (omeprazole), Reyataz, Reyataz/Norvir, and rifampin. |
