DIdanosine
NRTI
Tenofovir
NNRTI that is in NRTI class
Abacavir
NRTI
Zidovudine
NRTI
Stavudine
NRTI
Efavirenz
NNRTI
Delavirdine
NNRTI
Rilpivirine
NNRTI
Atazanavir
PI
Ritonavir
PI
Daranavir
PI
Maraviroc
Entry Inhibitor
Enfuvirtide
Fusion Inhibitor
Raltegravir
Integrase Inhibitor
Elvitegravir
Integrase Inhibitor
Dolutegravir
Integrase Inhibitor
Calbicistat
Pharmacoenhancer
Also pharmacoenhancer
Ritonavir
Didanosine + Tenofovir
Dec. CD4 paridoxically
EtOH + Abacavir
Inc. conc. Abacavir
Ribavirin + Didanosine
Fulmainant hepatic failure
Zidovudine + Stavudine
Antagonism (never see Stavudine due to toxicity)
Tenofovir + Atazanavir
Must be given with Ritonavir (T dec. A leading to PI resistance, A inc. T)
Atazanavir + PPI
DI
CYP with NRTIs?
NO
CYP with NNRTIs?
Hard to predict (INDUCTION or inhibition)
Most unpredictable NNRTI CYP interaction
EFAVIRENZ and Nevirapine
Rilpivirine + PPI
CI (requires acidic pH)
Warfarin + NNRTIs
inhibition/induction = monitor
Clarithromycin + NNRTIs
induction = dec. effects (use Azith)
Statins + NNRTIs
induction - dec. effects
PDE#s + NNRTIs
Less dangerous, titrate to effect of PDE#
CYP with PIs?
INHIBITION or induction
Warfarin + PIs
monitor closely
Voriconazole + Ritonavir
inhibition = dec. vori effects
BZDs + PIs
For intubation ok to use one time dose of midazolam or triazolam (short acting), ok to use LOT (no CYP)
Colchicine + PIs
Not recommended if renal/hepatic impairment and on PI
Statins + PIs
inhibition = inc. effects statins (Atorvastatin 10 = 40), Pravastatin is safest to use
St. John’s Wort + PIs
Dec. PI effects
PDE#s + PIs
Inc. effects of PDE# = risk of priapism
Advair + PIs
Fluticasone = steroid overload (use Beclamethasone instead), Salmeterol = increased risk of QT prolongation
Clarithromycin + PIs
Inc risk of metallic taste and GI effects due to inc. conc of Clarithromycin
Maraviroc + CYP drugs
CYP interactions
Enfuviritide DIs
NONE
Raltegravir dosing
BID (first line)
Elvitegravir/calbicistat dosing
QD (first line)
Do not eat with…
Efavirenz
Dolutegravir dosing
QD (first line)
Dolutegravir DIs
Don’t use with drugs that do not undergo CYP: CBZ, Phenytoin, Oxcarb, Rifampin
Nafcillin + Warfarin
Dec. INR
Warfarin + FAB 5
Flucon, FQs, Flagyl, Amio, Bactrim
ABX + OCs
Rifampin will lower OC conc., Bactrim will inc
Dapto + Statins
Risk of rhabdo (inc. risk of AE, not DI)
FQs/Tets + Multivalent Cations
Space out by 4 hours if possible
Eat with…
Rilpivirine (full meal), Elivitagrivir